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News & Trends - MedTech & Diagnostics

Health insurers clash with government on GUIs decision, prompting threat of premium hikes

Health Industry Hub | May 2, 2024 |

MedTech & Diagnostics News: A warning of potential increases in health insurance premiums for 15 million Australians has been issued by Private Healthcare Australia. This threat comes despite Federal Health Minister Mark Butler’s intention to ensure continued access to vital surgeries for patients who contribute their hard-earned dollars to health funds.

Yesterday, the Federal Government’s decision to wind-back the planned removal of General Use Items from the Prescribed List on 1 July was welcomed by the Australian Private Hospitals Association (APHA), Medical Technology Association of Australia (MTAA), Catholic Health Australia and the Australian Medical Association (AMA).

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.

PHA said in a statement “Health funds are extremely disappointed private hospitals have collectively rejected offers for fairer pricing of hundreds of medical supplies as part of the Federal Government’s reforms to the Prescribed List.”

APHA CEO, Michael Roff, emphasised “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.”

Ignoring severe backlash from surgeons for allegedly manipulating public perception of medical device reps working hand-in-hand with surgeons in theatres, PHA is calling for “an enforceable Code of Conduct to prevent upselling of general use items by sales reps in operating theatres, mandatory reporting of any kickbacks paid to hospitals or doctors, and a range of measures to remove incentives for the overselling and overpricing of commonly used medical items”.

AMA President Professor Steve 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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