A little-known list of medical devices used in surgeries is contributing to health insurance premium hikes despite repeated efforts for reform. Dubbed the Prostheses List, it covers about 11,000 items used by hospitals ranging from joint replacement components, dental implants and bone screws to soft tissue replacements, cardiac stents and artificial skin.
These devices are vital in modern medicine, however, in Australia they are overpriced and often over-used. Across the board, items on the list are up to 40 per cent more expensive than the same items in New Zealand, the United Kingdom or France. It is literally costing Australians an arm and a leg.
In Australia, the Federal Government sets the price for items on the list, determined by reference pricing, not market prices. Current policy requires private health funds like HIF to pay the prices set by our Government — no ifs or buts — and as a result the cost of care is rising.
To add insult to injury, benchmarking has shown that private hospital patients are paying nearly twice the price for items on the Prostheses List that public hospitals are being charged. This is the sign of a system that’s broken. The Protheses List is one of the most significant drivers of unsustainability in Australia’s private healthcare system with expenditure over the past ten years rising from $1.3 billion to $2.1 billion. At HIF alone, benefits for Prostheses List items have increased nearly 30 per cent in 10 years.
In response to this we’ve been seeking new ways to deliver positive patient outcomes both physically and financially, because we acknowledge the duty of care we owe our members. Last year, HIF partnered with Kieser Australia to offer members access to life-altering treatment programs that assist Australians suffering from chronic hip, knee, and spinal issues. Kieser’s programs are aimed at avoiding joint replacement or major spinal surgery, increasing strength, and improving quality of life. As a business, we are doing what we can to get by in the current system, but without reform there’s only so much we can do with a broken system. Without reform, private health insurance costs will continue to rise and be out of reach to many Australians, putting added pressure on the public health system.
HIF advocates for a reform pathway which could, over the next five years, return up to $2 billion to consumers and drive $240 million in savings to the public health system. This would include removing non-prostheses general items from the list and appointing an independent expert body to determine pricing and clinical efficacy. Reform is the only way we can fix a system that is costing us all.
Justin James (CEO - HIF Australia)
Source: Opinion Piece written by Justin James (CEO - HIF Australia) for The West Australian.