Surgeons welcome ‘significant win’ for patients, amidst clash with health insurers

MedTech & Diagnostics News: The Royal Australasian College of Surgeons (RACS) is heralding a significant triumph for Australian patients following the federal government’s announcement that health insurers will remain obligated to cover the expenses of vital surgical items.

This announcement comes in the wake of concerted lobbying led by the RACS, alongside the Australian Private Hospitals Association (APHA), Medical Technology Association of Australia (MTAA) and Australian Medical Association (AMA). Health Minister Mark Butler’s confirmation of insurers’ responsibility to fund General Use Items (GUI) represents a shield for patients against out-of-pocket expenses, especially amidst the current surge in the cost of living.

Previously, a policy shift threatened to abolish mandatory coverage for General Use Items (GUI) such as sutures, staples, and sealants from July 1, 2024. This move could have precipitated either escalated gap fees for patients or heightened financial pressure on private hospitals.

“This decision is a significant win for Australians,” said Professor Mark Ashton, who is a member of the RACS Health Policy and Advocacy Committee. “It safeguards patients from additional financial stress when accessing essential surgical care.”

In response, Rachel David, CEO of Private Healthcare Australia, articulated, “What we have now is a funding system that is commercially driven where the incentive is to drive more volume growth of generic items that are already significantly overpriced in Australia vs world markets. Claims integrity of the Prescribed List (PL) items is now the priority.”

In a rebuttal, John Cunningham OAM, Spine Surgeon, retorted, “You’re the CEO of the organisation charged with representing private health insurance companies and protecting their profits.”

RACS has also been actively engaged in consultations with the government regarding reforms to the Prescribed List (previously Prostheses List). Over the past two years, the College has consistently underscored the significance of preserving access and options for commonly utilised surgical supplies.

“Our focus has been on ensuring these reforms don’t restrict access to essential items,” explained Professor Ashton. “We particularly cautioned against a ‘bundling’ model that could limit patient choice.”

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