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News & Trends - MedTech & Diagnostics

APHA and MTAA lobbying shapes Health Minister’s decision on General Use Items, ensuring continued patient access

Health Industry Hub | May 1, 2024 |

MedTech & Diagnostics News: The Australian Private Hospitals Association (APHA), Medical Technology Association of Australia (MTAA), Catholic Health Australia and the Australian Medical Association have welcomed Health Minister Mark Butler’s decision today to maintain surgery critical General Use Items on the Prescribed List (PL).

The proposed removal of around 500 General Use Items (GUIs) from the PL would have had a significant impact on patient care. More than 70% of surgeries that would have been impacted by this change are performed on women, and regional hospitals with thin margins would have been worst affected. These include breast cancer procedures, caesarean births and bariatric surgeries.

Federal Minister for Health, Mark Butler MP, said “The Government has listened to the concerns about the pressure removing general use items would have caused and decided that this achieves the best outcome for patients. To maintain access to quality healthcare and to provide certainty to private hospitals and patients, the cost of these common surgery items will continue to be funded through the Prescribed List.”

MTAA CEO, Ian Burgess, said today’s announcement came following years of negotiation with government as part of reforms to the PL.

“MTAA commends the Minister for his decision to maintain the GUI items on the PL which will protect doctor choice and patient access to important medical technologies,” Mr Burgess said.

APHA CEO Michael Roff said the GUIs scheduled to be removed would have added additional and unnecessary financial pressure on the sector.

“Procedures like bariatric surgery, knee replacements, and cardiothoracic surgery would have been at risk in the private sector, potentially leading to increased demand on overstretched public hospitals.

“The health insurance sector had not been able to devise a sustainable funding model for GUIs, which would have left private hospitals managing increased costs at a time they could least afford it,” Mr Roff stressed.

He further added “Despite a range of proposals from different health insurance companies, none offered a viable alternative funding model with all of them shifting financial risk onto private hospitals. Potentially, this could have added $250 million in costs to the private hospital sector.”

Catholic Health Australia CEO, Jason Kara, commented “Private hospital patients around the country can today breathe a sigh of relief, knowing their health insurer will still be required to cover critical surgical items. The government’s commitment to upholding the funding for general use items is a crucial decision that will help ensure no patient is left behind, especially women and those in regional communities.”

AMA President Professor Steve Robson said he thoroughly welcomed the decision as a win for patients.

“With rising private health insurance premiums, this announcement will go a long way to ensuring patients are shielded from further financial pain from July 1,” Professor Robson said. “The AMA was extremely concerned that the former policy would see private insurers continue to squeeze the private hospital sector and make it more difficult for patients to access services.”

Health insurers have already achieved significant savings on these items as they have been subject to full public sector reference pricing. This has contributed to an industry-wide profit of $2 billion for health insurance companies.

“While private hospitals have been facing significant financial pressures, with services and in some cases entire facilities closing, health insurance companies have enjoyed a period of super profits.

“APHA has been advocating GUIs should remain on the PL for many years, we were successfully able to have removal deferred for 12 months last July when the timeframe for implementation was unreasonable. Now the Minister has recognised that pushing on with removing these items from the list would cause unnecessary additional financial stress to the private hospital sector,” Mr Roff commented.

Today’s decision will also allow the listing of new GUI technologies which has been held up by the planned removals. The continued availability of GUIs on the PL ensures surgeons and patients are able to benefit from the latest and best in class technology when having surgery in the private health system.

Mr Burgess stated, “It is thanks to the joint advocacy of private hospitals, doctors, patient groups and MTAA that the right decision has been made that most importantly, puts patients first. This will give the private health sector the much-needed certainty to continue to provide the latest and best MedTech to insured Australians.”

Professor Robson said further reforms are still required to ensure the private health system remains viable and that consumers get real value for money from their private health insurance.

“Private health insurers should be required to return 90% of private health insurance premium revenue paid each year back to consumers in the form of benefits for treatment,” Professor Robson said. We have also been calling for a truly independent and well-resourced Private Health System Authority to bring all relevant stakeholders together and drive much-needed reform.”

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