Private Health Insurance - Prostheses List Reforms

Page last updated: 01 October 2019

In October 2017, the Government and the Medical Technology Association of Australia (MTAA), as advocates for Australia’s innovative medical technology sector, reached an agreement to:

  • promote the sustainability of privately insured health care through rebalancing the costs of medical devices to privately insured patients, to help keep private health insurance affordable for all Australians;
  • support a viable, innovative and diverse medical technology sector in Australia and local jobs; and
  • improve the value of private health insurance for consumers by reducing benefits for prostheses on the Prostheses List.

Agreement between the Government and the Medical Technology Association of Australia (MTAA)

Australian Government and MTAA Agreement 2017 – 2022: High Level Workplan

The Agreement Workplan will form the basis of the work the Government intends to undertake to:

1. Support sector stability and sustainability

2. Reduce the time to market for medical devices

3. Ensure Australian patients have access to safe, effective, and cost effective innovative medical devices in the private sector

4. Improve the transparency and efficiency of the Prostheses List arrangements

5. Recognise superior clinical performance

6. Support Australian medical technology innovation

PDF version: Agreement Workplan (PDF 403 KB)
Word version: Agreement Workplan (Word 33 KB)

Prostheses List Review of the General Miscellaneous Category

The Department of Health will undertake a review of the General Miscellaneous category of the Prostheses List to determine whether items listed in that category (or a subset of items) should continue to be listed on the Prostheses List. In doing so the Review will take account of the overall purpose of the Prostheses List.

PDF version: Proposed Terms of Reference (PDF 146 KB)
Word version: Proposed Terms of Reference (Word 20 KB)

Cardiac ablation catheters for atrial fibrillation

Background

As at 1 March 2019, cardiac ablation catheters for atrial fibrillation are included on Part C of the Prostheses List.

Key issues

The PLAC report Cardiac ablation catheters: consideration of Prostheses List inclusion and its attachments are listed below:

Cardiac ablation catheters: consideration of Prostheses List inclusion

Attachment 1: Review of high-level clinical evidence

Attachment 2: Economic evaluation Focused financial analysis

The initial economic evaluation found that cost-effectiveness was most sensitive to the price of the devices. The economic analysis made assumptions on prices of devices ranging from $2,340 for a simple mapping catheter through to $6,000.

An extended economic evaluation was undertaken incorporating advice provided by MSAC at its meeting of 22-23 November 2018. The evaluation was provided to the MSAC Executive and the PLAC to inform consideration of a cost-effective benefit at which to list cardiac ablation devices for the treatment of atrial fibrillation. This report is provided below:

Extended economic analysis

MSAC’s consideration of cardiac ablation for atrial fibrillation can be found on the
Medical Services Advisory Committee website (www.msac.gov.au/internet/msac/publishing.nsf/Content/1580-public)

Questions or comments

If you have any questions or comments please email prosthesesreform@health.gov.au

PDF Version: Options Paper (PDF 113 KB)
Word version: Options Paper (Word 48 KB)

PDF version: Attachment 1 - Review of high-level clinical evidence (PDF 2063 KB)
Word version: Attachment 1 - Review of high-level clinical evidence (Word 1079 KB)

PDF version: Attachment 2: Economic evaluation Focused financial analysis (PDF 1388 KB)
Word version: Attachment 2: Economic evaluation Focused financial analysis (Word 591 KB)

PDF version: Extended economic analysis (PDF 460 KB)
Word version: Extended economic analysis (Word 213 KB)

Two year clinical evidence requirements

PDF version: Two year clinical evidence requirements (PDF 73 KB)
Word version: Two year clinical evidence requirements (Word 18 KB)

Prostheses List Reform Governance Group

The Governance Group will monitor the implementation of the Australian Government – MTAA Agreement and oversee the operation of the three Industry Working Groups. It will define performance data to inform the evaluation of the Agreement and consider the management of commercially sensitive information during this program of work. The Agreement will be reviewed by the Governance Group in 2021.

PDF version: Prostheses List Reform Governance Group Terms of Reference (PDF 226 KB)
Word version: Prostheses List Reform Governance Group Terms of Reference (Word 162 KB)

Industry Working Groups

As part of the agreement with the MTAA, the Government committed to establish three working groups:

  • Revised Benefit Setting and Review Framework Industry Working Group to develop a revised framework for benefit setting and benefit review.

PDF version: Revised Benefit Terms of Reference (PDF 1014 KB)
Word version: Revised Benefit Terms of Reference (Word 81 KB)

  • Cardiac Technical Support Services Industry Working Group to determine how technical support services for active implantable cardiac devices should be funded.

PDF version: Cardiac Technical Terms of Reference (PDF 994 KB)
Word version: Cardiac Technical Terms of Reference (Word 83 KB)

  • Quality of Information and Guidance Industry Working Group to improve the quality of information provided to applicants in the Prostheses List – Guide to Listing and Benefits (the Guide) and the Prostheses List Management System (PLMS).

PDF version: Quality of Information Terms of Reference (PDF 390 KB)
Word version: Quality of Information Terms of Reference (Word 207 KB)

Further Information

Australian Government MTAA Agreement news and communiques

For further information please contact prosthesesreform@health.gov.au