10 Facts about the Prostheses List

The Prostheses List might not be well known but every day it plays a crucial role in providing access to life-saving medical devices for consumers with private health insurance.?

The Prostheses List is the funding mechanism for implantable medical devices used in procedures covered by health insurers. It is administered by the Federal Department of Health and was set up under the Private Health Insurance Act 2007.??

Currently there are around 11,000 items on the Prostheses List which sets the minimum fee that insurers must pay on behalf of consumers.?

Here are 10 essential facts that everyone should know about the Prostheses List:?

1.?????The Prostheses List exists to protect privately insured Australians by ensuring insurers cover the cost of prostheses for private patients.

2.?????The Prostheses List ensures consumers and their doctors can choose the most clinically appropriate prosthesis to suit their needs, rather than being restricted to devices stipulated by insurers.

3.?????A prosthesis must be approved by the Therapeutic Goods Administration before it receives guaranteed access through the Prostheses List.?

4.?????The Prostheses List Advisory Committee advises the Minister for Health to list devices after assessing their clinical and cost effectiveness compared to other similar products.

5.?????Medical device companies pay a fee to the Department of Health for each product they have listed on the Prostheses List. Companies that make joint replacement prostheses also pay an annual levy for every item tracked on the National Joint Replacement Registry.?

6.?????The Prostheses List is updated three times a year to ensure consumers have access to continuously improving medical technology.

7.?????Usually, consumers don’t pay out-of-pocket for devices on the Prostheses List.

8.?????Prostheses prices have been steadily falling over the past two decades. Since 2005, on average, benefits for prostheses have decreased. For example, the price for Australia’s most commonly used hip prostheses has fallen 29.5 per cent since 2015.

9.?????Prostheses costs comprise around 10% of total benefit payments by private health insurance funds.?

10.??In 2017 MAA agreed with government to reduce the cost of prostheses. This agreement has delivered over $1.1 billion in savings to private health insurers.??The MTAA entered this agreement with the government with the good faith that all savings would be passed on to consumers in the form of lower insurance premiums. However, there is no evidence showing the savings created by medical device companies have been passed on to consumers, while insurers’ profits have steadily increased.??