Private health insurance reforms 2019: Prostheses price reductions

How will the new prostheses price reductions make private health insurance more affordable?

Prostheses price reductions are part of a large range of reforms currently being rolled out by the Australian government, aimed at simplifying private health insurance (PHI).

The Australian government helped the insurance industry negotiate better prices for prostheses, with the intention that the savings would be used to combat rising premiums. On 1 February 2018 the new price structure kicked in and it will eventually save insurers $1.1 billion over 4 years. More reductions are expected in 2019 and 2020.

What's changing for prostheses benefits?

The minister for health, Greg Hunt announced the changes back in October 2017, stating that the price payable by private health insurers for almost all medical devices on the Prostheses List would be reduced (reductions vary by category). The 2018 round of price reductions has already saved private health insurers $188 million.

The changes put in place will reduce prostheses costs without reducing patient outcomes. In other words, the changes will not reduce the value of PHI to you as a consumer. The reforms aim to increase transparency and improve costs in a number of ways:

  • Separating the cost of services from the cost of the prosthesis device.
  • Although in the public sector, prostheses are mostly purchased in bulk, while private prices are based on a single purchase at a time, the reforms aim to bring the price of prostheses in PHI closer to what's paid in the public sector.

How will this affect you?

People who receive prosthetics won't notice any difference in their cover or in their treatment, and they won't notice any direct changes in the way they are billed for services or charged in premiums. Instead, this is meant to benefit all PHI holders. Now that insurers are paying less for prosthetic devices, they can use those savings to put downward pressure on the cost of everyone's premiums.

That means you should end up paying less for your insurance over the coming years than you would have if this change had not been implemented - regardless if you need prosthetics or not.

Will it impact your wallet?

These changes should help lower your premiums, but only if insurers keep their promise. It's essential that they pass on to consumers the savings that these reductions create. The Medical Technology Association of Australia has been more sceptical, issuing a warning to consumers, "Given the scale of the reductions... 13.5 million members need more than just a 'trust us'[1]."

Why are benefits for prosthesis changing?

Prostheses are an expensive part of the medical industry. In fact, expenditure on prostheses accounts for 14% of PHI hospital benefits paid annually. Private Healthcare Australia CEO Dr Rachel David has said that, "Prostheses List regulations have forced health funds to pay benefits for medical devices two to five times higher than the price charged for the same device to public patients."

A major issue then, is that Prostheses List benefits are generally inflated when compared to the equivalent prices paid for devices in the public sector. That's why the government has targeted prostheses, as it's clearly an area in need of reform. By reducing prostheses expenditure, there will be incentive for insurance companies to lower your premiums.

When's it changing?

The first change came into effect on 1 February 2018, with subsequent reductions planned in 2019 and 2020. Because it's such a huge overhaul, going through and calculating reductions while ensuring the quality of service isn't compromised, takes time.

What else is changing for Australian healthcare?

These reforms are part of a major overhaul by the government targeting a whole range of issues surrounding private health insurance.
Picture: Shutterstock

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