The interim report of the National Health and Hospitals Reform Commission was released yesterday, and most of the coverage seems to have focused on the proposal for “Denticare” – a universal dental health scheme. Dentists and private health insurers seem to be unenthused about the idea, though the distinct whiff of self-interest can be detected from both groups.
There are a lot of other seemingly worthy reforms proposed in the report – notably including an emphasis on primary care and prevention. However, as the interim report itself acknowledges, by far the most complicated and potentially most rewarding, in terms of improving the value for money we get from our health system – is untangling the mess of overlapping responsibility and funding between state and federal governments. The commission proposes three options, and I quote from the report:
- Option A – continued shared responsibility between governments, with clearer accountability and greater Commonwealth responsibility for some functions.
- Option B – Commonwealth to have sole responsibility for all aspects of health care, with delivery through regional health authorities.
- Option C – Commonwealth to have sole responsibility for all aspects of health care, with establishment of compulsory social insurance to fund local delivery of health services.
Needless to say, options B and C represent a radical change in how things are currently done, and if attempted would surely be one of the defining achievements the Rudd government, for better or worse. Watch this space.
Any reason why dentistry can’t just be included in medicare?
Public dentistry is in such a heinous state that something really needs to be done. Working in rural pharmacy, I see some really astounding tooth decay, and people in pain who go from having a small cavity to losing 2-3 teeth in the time it takes for them to see a dentist. Even private dentistry is bad – 2 week wait for an emergency appointment, 6 week minimum wait for a filling *after* a preliminary check-up. And I know my area is not the worst off. Even if there’s just partial cover, or cover for under-18s and over-65s, it would do a lot to improve quality of life.
The main issue for me, in considering a Commonwealth takeover, is wondering if it can improve rural health and mental health, both of which are pretty appalling. The idea that Roxon’s committee floated of attaching patients to a particular clinic and providing unified health records is a fantastic one for people with complex health needs, which will be an increasing number of people as the Baby Boomers age. Although, if access to healthcare professionals (especially mental health professionals) remains as poor as it is currently, it will do little good to have unified health records and no treatments or specialists to read them!
I would have thought the distinct whiff of self-interest would be coming from all concered with this report, but especially the doctors who managed to see off non-doctors getting wider MBS and PBS rights in metropolitan areas. The champion, and still the most powerful union in Australia, is …
kymbos @ 1 – simple – cost.
Denicare sounds a lot like duplication. Just expand the Medicare schedule – its already been expanded to include optometry, and some other allied health items.
Gah. Denticare even.
Razor, are you suggesting the high cost of dental care is a good reason to prefer a parallel ‘denticare’ over incorporation into Medicare? Please explain.
Dentists will resist Denticare as long as they are drawing breath. They have observed the relentless squashing of GP’s incomes courtesy of the Medicare benefits schedule – remember when GPs were among the highest earners in society? – and they’re not going down without a fight.
Which isn’t to say it shouldn’t happen. It should happen. If it’s good enough to get fixing your bunions paid by Medicare, it’s good enough to get your tooth decay sorted the same way.
Things must have been pretty good for GPs in the old days then, Spiros. My doctor and his practice partner still update their Mercedes and Range Rover every couple of years (both of which have snow ski racks permanently attached in winter), work only 3 1/2 weeks and send their kids to private schools.
Basic dentistry should have always have been part of Medicare as bad teeth can cause or exacerbate so many other illnesses.
“work only 3 1/2 weeks”
Should have been “work on 3 1/2 days a week”
As a matter of principle I think any increased centralization and concentration of power needs to be balanced so that the overall size and reach of the main power center actually shrinks over time. This is easily done through trade-off or offsets. For example we get Denticare and the defense department misses out on a new jet fighter. The alternative is that the state sector gradually takes over everything and that’s unacceptable.
I hope that they don’t increase the medicare levy, but instead abolish it and just raise the income tax rates to compensate. People get mislead into thinking that the medicare levy is indicative of how much the health system costs to run.
Spiros @ 8 – was talking to a dentist the other day who has worked in the past as a public dentist – the pay is so bad compared to their private work they think of it as community service work.
Why oh why.
How’s about people eat better in the first instance? It would reduce dental & medical cost significantly.
How’s about putting a 5 cent levy on soft drink & fast foods. How’s about a federal discount on whole foods & fruit n veg.
Dreaming!
I can’t see Rudd going for anything other than option A which is the status quo with all the expected genuflections towards ‘clearer lines of responsibility’ between state and commonwealth. Of course there was an election commitment that if the states couldn’t do their bit and the public demanded it, Canberra stood ready, but somehow I think Rudd would baulk at taking that next step, ie option C. But I could see it being a second, or third, term election winner. The recalcitrant dentists could be the whipping boys for something like Hawkie’s demolition job on the airline pilots.
Adam@13
Why not use the levy to subsidise denticare?
The only health reforms that Nicola Roxon is really serious about are GP Super Clinics and Nurse Practitioners. She is obsessed with setting up these white elephant polyclinics in marginal seats – often areas that are already struggling to find and retain doctors, hence the need for nurse practitioners. The only people to benefit from these health reforms will be the extra layer of health managers hired to handle all the paperwork they create. Don’t forget these health reforms have to be cost neutral. There’s no money in the health and hospitals fund piggy bank – it all got spent on your $950 stimulus. Save it for when you get sick.
I reckon a lot of the problem with peoples teeth is the recent fad for drinking bottled water. My own teeth are shocking (pre-flouridation), although they’re better than my mother’s were, but anyone younger than about 50 (in SA), including my children, don’t have fillings. Preventative health care is way better (and cheaper) than intervention.
“anyone younger than about 50 (in SA), including my children, don’t have fillings. ”
My 5yo has six fillings!
Options B and C terrify me. My view is that the Commonwealth Public Sector is a world leader in waste and inefficiency. Its bureaucrats are overpaid fatcats in perpetual meetings, endlessly stroking each other while they pretend that they have some relevance to the function they are allegedly administering. The States aren’t great but at least the bureaucrats are answerable to their communities and aren’t awash in the junkets and perks that are typical of any Commonwealth agency. I know that NSW is in the habit of complaining about its State administration of health, but I suspect you’d find on closer examination that, as with all the states, the real problems are declining contributions from the Commonwealth, increasing medical costs and excalating public expectations.
Jenny: fair point, but at the moment you’ve got a situation where all three levels of government are responsible for the health system, and so you’ve got endless opportunities for cost-shifting and blame-shifting.
And duplication.
Praise the FSM that it has finally dawned on our government that the teeth are a part of the body. It did take a while.
Unfortunately, I doubt it’ll include orthodontics; just received a $5000 quote last night.
“The only health reforms that Nicola Roxon is really serious about are GP Super Clinics and Nurse Practitioners. She is obsessed with setting up these white elephant polyclinics in marginal seats – often areas that are already struggling to find and retain doctors, hence the need for nurse practitioners.”
Having up and walked from emergency, after a spider bite, when I realised my chances of seeing somebody in less than three hours was zero I applaud her obsession. Any plan to free up hospital ‘first call’ is a winner. Nurse practitioners should have been running on a large scale years ago. They have only been left out of the game because of doctors protecting their own patch.
Agreed in principle, Adam at 13, however the reality is there are thousands of elderly, and maybe not so old, Australians whose teeth are in such terrible shape and in such awful pain it amounts to a widespread need now for emergency dental and medical treatment. If you’ve only suffered one weekend of tooth pain without available help you can’t help but empthasise. Free dental treatment was one of the features of the British health scheme in post-war Britain and as a child I watched the miracle transformation of my mother from a hollow cheeked hag into a smiling and pretty woman with a mouthful of new teeth. Her five children soon had regular school dental check ups and treatment along with eye tests. I still recall the miracle of being able to read the blackboard at school and feeling as if the whole world had had a wash! Still having all my own teeth at a reasonably advanced age is something I owe to the British National Health Scheme and Aneurin Bevan. I don’t resent paying to maintain them privately in Australia, but I haven’t forgiven the Coalition for carving up Labour’s Medicare, and throughout the Howard years I cursed him for the pain he was inflicting on the elderly by his abandoning of dental health programs.
Rang to try and get into the mens clinic at Epworth Freemasons, and September is the earliest they can see me.
If you want to get in immediately, Zorronsky, just give them the secret handshake.
Heh! Thumb twitch?
I’m all in favour of extending fillings, etc into the Medicare schedule. The trouble is that, on top of the long-run problems of privatised medical care run in the interests of providers, we have a shorter run problem due to the disastrous mis-forecasting of demand for dentists in the 1980s and 90s – which led to fewer dentistry places at uni, which led to a massive shortage of them now even for those who can pay. If we want universal dental care then in the short run we’re gonna have to import a lot of third world dentists, however we fund it all.
Oh, and Chris is right about the Medicare levy. On top of being problematic in principle (it leads punters to massively underestimate the cost of healthcare) it is shockingly designed in detail. Mind you, I’ve always thought that may have been deliberate – the Treasury people who designed it in 1983 hated the general idea and wanted to kill it.