The Prostheses List is produced by the Australian Government Department of Health and Ageing and sets the amount of benefits to be paid for privately insured patients requiring a prosthesis. Prostheses include implantable devices such as hips, knees, spinal plates and cardiac devices. Over the past three years since the current Prostheses List process was introduced the number of products on the List with gaps has grown significantly from 1.2% or 111 items in November 2005 to 6.4% or 602 items in August 2006 to 15.8% or 1469 items in July 2008. This represents an increase in the number of gapped items of more than 130% in less than 2 years for continuously listed items.
These changes will have implications for privately insured patients who require an operation using a surgically implanted prosthesis. While the same prosthesis is available in the public system at no cost to the patient, there are usually long waiting periods.
"There have been significant increases in gaps over a short period of time. These gaps will be met by the patient who is also subject to the ongoing increases in health insurance premiums" said Anne Trimmer, MTAA CEO.
"The rise in gaps for medical technology, on top of co-payments for doctors will impact negatively on patients. The gaps will also reduce patient access to appropriate medical technology" Trimmer continued.
MTAA believes that there needs to be a fundamental review of the role of medical technology in the healthcare system, in particular the need to ensure equity of access to appropriate medical technology by patients.
The system that currently regulates and funds medical technology through processes such as the Prostheses List is out of date, poorly-designed and not sufficiently flexible to keep pace with the rapid development in medical technologies.
The system needs to better value the benefits and potential cost-savings to the healthcare system which are provided by medical technologies. At present there is an ill-equipped mechanism to identify and value these benefits "MTAA proposes a revision of the current system for evaluation and funding of complex medical technologies to replace the current Prostheses List which only provides reimbursement for patients who are privately insured" Trimmer concluded. "Furthermore, there are many medical technologies that are not classified as implantable prostheses and are therefore not reimbursed for private patients".
The Prostheses List is available at http://www.health.gov.au/internet/main/publishing.nsf/Content/healthphicirculars2008- 25_08.htm
The Medical Technology Association of Australia (MTAA) is the national peak industry body representing companies in the medical technology industry. MTAA aims to ensure the benefits of modern, innovative and reliable medical technology are delivered to the community for a healthier Australia. www.mtaa.org.au
