Less choice for doctors and patients in sight? 


Alcon's Karen Fowler says the 'devil is in the detail' when it comes to reform of funding for medical devices but that any changes should not do anything to undermine access and choice.

An ageing population means a growing number of Australians will suffer from some form of sight loss in the future. 

According to the Australian Bureau of Statistics, over 13 million Australians have one or more chronic (long-term) eye conditions – including 411,000 with cataract. And with its close association with ageing, eventually, nearly everyone will develop a cataract if they live long enough.

Private health insurance ensures Australians needing to access cataract surgery are covered and have choice – the ability to access treatment in public or private hospitals as a private patient, and their doctor of choice. 

Cataract surgery is the most common procedure for admissions from elective surgery waiting lists. Australians can wait up to a year (334 days) to access

cataract surgery in the public hospital. 

For some, persisting with poor vision for up to a year to be treated in a public hospital may not be worth the risk – especially considering modern cataract surgery is a highly effective and cost-efficient procedure with a low risk of complications.

Just as important, investing in private health insurance also means a patient’s doctor can choose the best technology for them at their time of clinical need, without out-of-pocket costs. 

Advanced medical devices are transforming eye care - and their impact goes beyond improved visual outcomes for patients. In the case of cataract, worsening vision leads to impediments in daily activities, a higher risk of falls and depression. 

For Australians needing surgery for cataract, private health insurance has delivered value by enabling access to the most suitable medical technology for their needs as well as the doctor of their choice, without the stress of unforeseen out-of-pocket costs. 

Patients trust their private health insurance to cover them for their hospital and procedure costs. Under the current system patients are covered for advanced medical devices or ‘prosthesis’ that works for their individual clinical circumstances - regardless of the cost of that item. This gives them value from their insurance. 

But, less choice for doctors and patients may be in sight following the Government’s recently announced changes to access to medical devices through private health insurance. 

On the surface, the proposed reforms promise reduced private health insurance premiums as well as increased private health insurance ‘coverage and affordability’. However, when we examine closer, one could say the devil is in the detail. 

The government’s 'Modernising and improving the private health insurance Prostheses List' could ultimately mean reduced clinical choice of prosthesis by the medical practitioner, as well as limited access to the full range of prosthetic items to suit patients’ different clinical needs. 

This will ultimately mean that patients, despite having private health insurance, may in the near future, incur out-of-pocket costs for a prosthetic item/s. 

Privately insured patients who don’t see the value will opt out and join ‘the year-long wait’ to have their cataract surgery in the public system or pay an out-of-pocket cost so they have choice of an advanced medical device. Sadly, for many Australians, this cost would be prohibitive. 

Australia has a world-class health system and we should strive to continue to maintain a high standard when it comes to medical advances – especially where Australians are at risk of losing their vision. Consumers need to know the value they receive from their private health insurance – and that requires greater transparency from our healthcare system – a system that is promising to deliver the best health outcomes for Australians. 

Karen Fowler is the country manager and cluster franchise head for surgical at Alcon Australia and New Zealand.