Medical device companies say reforms proposed by private health insurers that appear to have the government's support will restrict access to new technologies.
The federal government's Prostheses List (PL) sets privately insured funding arrangements for medical devices.
It has been the focus of reforms for several years. In 2017, the Medical Technology Association of Australia (MTAA) agreed to price reductions to reduce private health insurer spending on devices by in excess of $1 billion over several years.
However, the push for wider reform has continued. Late last year, the Department of Health launched a stakeholder consultation process on options for the reform to the Prostheses List, including the adoption of health technology assessment, cost-recovery and new funding arrangements for low-cost high-usage items.
Private health insurers have also proposed a range of specific reforms.
These include the removal from the PL of 67 'non-prostheses' groups comprised of items such as adhesives and sponges.
They have also proposed the phased adoption of an episodic diagnosis-related group (DRG) based prosthesis funding model. This would involve the independent setting of reimbursement amounts based on the 'bundled' prosthesis component of a procedure.
In response, the MTAA says the changes could mean new restrictions on the ability of surgeons to select medical devices.
According to MTAA CEO, Ian Burgess, the changes could lead to the effective abolition of the Prostheses List.
“The Prostheses List is an essential part of the value of private health insurance enabling Australians to receive the best quality healthcare as determined by their chosen doctor, with the intention to ensure Aussies covered by Private Health Insurance face no unnecessary out-of-pocket or unexpected costs for access to medical devices that will save or improve their quality of life,” said Mr. Burgess.
“Should the proposed reforms to the Prostheses List go ahead, the choice of medical devices could end up being dictated by private health insurance providers, with no input from healthcare professionals and surgeons around how to best treat their patients.”
Mr Burgess continued, “These proposals, which the Department of Health has shown a strong inclination to support, effectively mirror the public system which greatly limits choice and focuses on using the cheapest items. The protection provided for private patients by the PL would be lost. This is not what health insurance members sign up for.”
The MTAA said the impact of the reforms could extend to Australians medical research, R&D, as well as clinical and educational support for medical professionals.
“Any model which reduces the price paid to suppliers reduces their ability to provide clinical support services, for example, a cardiac device supplier locked out of the private tendering market in Australia may not be able to continue to provide the same high level of technician support service for the implanted base of devices already implanted,” said Mr Burgess.
“Industry support for educational activities through educational grants and direct training workshops and proctorships, fellowships and clinical trials are also likely to be significantly limited.”