New category comes under scrutiny in prostheses list review


Spinal categories have joined hip, knee and cardiac categories to come under scrutiny by the Prostheses List Advisory Committee (PLAC) under targeted reviews announced by Health Minister Greg Hunt.

The outcome of the reviews, together with input from industry, will “inform options to improve the prostheses arrangements and potential savings’’ the Minister said.

The Minister has framed the review as a way to recognise savings and reduce private health insurance premiums.

“We want to help medical device sponsors, private hospitals, day hospitals and private health insurers to identify ways to reduce costs – without reducing patients’ benefits or quality,” he said.

Australian Private Hospitals Association (APHA) CEO Michael Roff said the association supports the work of the PLAC, which is the right place to for these discussions and deliberations.

“We believe the process outlined by Government should be properly worked through. Arbitrary cuts to the prostheses list could result in increased gap payments for patients, negating any premium drop.

Mr Roff said a faster and less complex way to cut premium increases was to stop private patients being treated in public hospitals.

“This practice rorts upwards of $1 billion that could be cut from health insurance premiums every year, having an immediate effect on the family budget.

He said reform the prostheses list should also consider adding new technologies to the prostheses list.

“New medical device technologies have been introduced to Australia that save lives and improve quality of life post-surgery for thousands of Australians. Unfortunately, they don’t meet the prostheses list criteria that would make them affordable for consumers,” said Mr Roff

The announcement builds on comments the Minister made last week when he promised to ‘’do more’’ on prostheses and on private patients treated in public hospitals.

“I think we can do more on prostheses, I think we can do more on the issue of private patients in public hospitals.

“Both of those offer significant opportunities for reducing the pressure on private health insurance, which in turn reduces the pressure on public waiting lists,” said Mr Hunt.


For more on the PLAC's targeted prostheses categories reviews, visit the Department of Health's website

Desired outcomes of the review:

  1. the prostheses list only provides benefits for medical devices that are clinically effective and cost effective,
  2. privately insured patients are left with minimised out-of-pocket expenses,
  3. private hospitals and medical device sponsors receive fair and equitable remuneration for their goods and services; and
  4. private health insurers are not required to pay more in benefits for prostheses and associated services than is fair and reasonable.



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