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News & Trends - Medical Technology

Health insurers must not wriggle out of paying for essential medical devices, says Catholic Health Australia

Health Industry Hub | August 3, 2022 |
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MedTech News: A group of over 400 general use and consumable medical devices have been identified by the Clinical Implementation Reference Group (CIRG) for removal from the Prostheses List on 1 July 2023.

In this Health Industry Hub podcast, Caitlin O’Dea, Health Policy Director at Catholic Health Australia (CHA) reflects on CHA’s involvement in the Prostheses List reforms, her perspectives on funding arrangements for the general use items on the PL, and concerns that have been raised by CHA hospitals and clinicians regarding the significant impact on patient care if the private health insurers refuse or delay committing to the updated funding arrangements.

To shed light on the current process, Australian Private Hospitals Association (APHA) CEO, Michael Roff, told Health Industry Hub “The Independent Hospital Pricing Authority (IHPA) is in the process of developing bundled pricing arrangements for the general use items to be removed from the PL in 2023. This will be based on prices resulting from a full set of reference pricing reductions that will deliver significant savings to health insurers.

“We are aware some private hospitals have attempted to negotiate new clauses in health fund contracts that the health fund would undertake to pay the IHPA determined price for the bundles. So far these efforts have not been successful.”

Mr Roff added “Concurrent with IHPA’s work on bundling, the Department of Health is developing an options paper to explore both regulatory and non-regulatory options for implementation of the bundles that would provide certainty to private hospitals that the bundled prices will be honoured by health insurers. This is essential as private hospitals have experienced significant revenue reductions and cost increases as a result of the pandemic, and are not in a position to absorb the cost of items removed from the list. Therefore, if health funds do not voluntarily agree to pay the IHPA determined price, the Department will have no option but to mandate a benefit the health funds must pay.”

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