Dental plan 'needs Medicare levy rise'

Taxpayers would be charged a higher Medicare levy to fund a universal dental scheme under a radical proposal by the federal government's health reform body.

Accommodation bonds for high-care nursing home residents was another idea floated by the National Health and Hospitals Reform Commission in its interim report, released on Monday.

Commission chairman Dr Christine Bennett told the National Press Club in Canberra that about 670,000 adults were on public dental care waiting lists, with an average waiting time of 27 months.

The commission has recommended a 0.75 per cent increase in the Medicare levy to pay for a scheme, called Denticare Australia, which would replace existing premiums paid for private dental insurance.

"(Denticare) would give every Australian universal access to preventative and restorative dental care and dentures, regardless of a person's ability to pay," Dr Bennett said.

Health Minister Nicola Roxon said the government was committed to long-term health reform, despite a looming recession.

"They (the commission) have put forward a fairly radical proposal, obviously the way of delivering the services, and a tax, an extra levy attached to it, it is a fairly ambitious proposal," she said of Denticare.

"But we are interested in the community's response to this issue. I think people do feel that something new is needed in dental care."

Australian Dental Association president Neil Hewson said targeted funding was a better approach than a universal scheme.

"Denticare, as is suggested by the commission, is not necessary and would be fiscally irresponsible and unlikely to deliver quality dental care," he said.

Dr Bennett said Australia's aged-care system needed to be overhauled to respond to changing consumer expectations.

"We recognise that providers will need to be able to raise revenues to invest in expanded places and offer greater choice," she said.

"We therefore suggest that accommodation bonds, and other alternative approaches for payment, be explored."

A spokesman for Ms Roxon said the government was not currently considering introducing bonds in high-care.

The commission called for the Commonwealth to take over responsibility for primary care, that is services provided outside of hospitals by professionals such as GPs and physiotherapists.

But it stopped short of recommending a takeover of state hospitals, instead putting three options forward for discussion.

Under the first model, responsibility for the nation's health system would continue to be shared by the Commonwealth and the states, while the second model advocates a federal takeover of the system, with services delivered by regional health authorities.

The third and most radical option is a socialisation of the system, whereby the Commonwealth would be responsible for health-care and establish a compulsory social health insurance scheme.

Ms Roxon described the third option as radical, while Australian Medical Association president Rosanna Capolingua said it seemed to be similar to the model in the United States where private health insurers controlled the system.

"What happens there is that when you have something wrong with you that doesn't fit into the plan then there is no one to look after you," Dr Capolingua said.

The health minister repeated the government's threat to hold a referendum on whether or not Canberra should assume control of public hospitals if the states don't lift their game by the middle of the year.

But despite that deadline being just four months away, Ms Roxon again refused to reveal exactly what the trigger point for such action would be.

The commission will provide its final report to the government at the end of the year.

NSW Health Minister John Della Bosca said NSW was happy to discuss further reforms, so long as they made a positive difference to health service delivery.

"They key issue here is not who controls what, but making sure we have the proper resources for patient care and safety in our public hospitals," he told reporters.

He said priority should be given to ending "cost shifting and blame shifting and making sure we get rid of the red tape."

"It's very clear the commonwealth wants to work with us to redefine the roles and relationship in health care."

Mr Della Bosca said families were most concerned about being able to find a GP when they needed one, having access to emergency departments, and undergoing planned surgery when they needed it.

"Any recommendation for change must address those fundamentals," Mr Della Bosca said.

"Unless we are prepared as a nation to provide public health with funding that recognises the growing demand for services, then we cannot meet the community's expectations."

Queensland Health Minister Stephen Robertson says a federal takeover of hospitals could spawn a bigger bureaucracy less responsive to patients' needs.

Mr Robertson said the report was a good start for discussions between the federal and state governments on health reforms.

"What we need to do is check our own self interest at the door and remember that our first priority must be establishing health services in Australia that put the patients first," Mr Robertson said.

"If that means the states lose some responsibilities or gain some responsibilities, then we've got to have an open mind about it."

The commission raised a federal takeover of hospitals as an option only, but said it could have the advantage of making one level of government accountable for all health care.

Mr Robertson said he was open minded about the division of health responsibilities, but urged caution.

"Running on-the-ground services from Canberra, where you understand the differences between Cape York and Launceston and Perth and Melbourne, is not easy," he said.

"Before people go rushing down the path of saying Canberra could do a better job, I think they need to be very, very cautious about jumping to that conclusion.

"It may well do (lead to a bigger bureaucracy) or a health system that is less responsive to the needs of our various communities."

Mr Robertson said he was pleased the report had highlighted the need for better commonwealth funding of dental services.

Queensland funded dental services better than other states and performed well in the area of emergency care, but could use help to get more people into check-ups, he said.