Essential Care List

Essential Care List

The health system needs to better value the benefits and potential cost-savings to the healthcare system which are provided by medical technologies. At present there is an ill-equipped mechanism to identify and value these benefits. Medical technology is very much subject to the cost-shifting and silo-ed structure of the healthcare system. Medical technologies frequently are not readily accessible, or accessible without subsidy and at a cost to the patient, or available only after considerable, lengthy and linear processes for regulation, evaluation and assessment for reimbursement. These processes are unnecessarily time-consuming and often lacking in transparency. There is no clear framework and very little evidence base to funding decisions.

MTAA is calling for the establishment of an Essential Care List scheme to ensure that sub-acute care medical products needed by patients for their care, and in some cases, survival, are readily available using a system that is equitable, transparent, and affordable. The scheme for an Essential Care List will enable subsidised access to essential care medical technologies that provide necessities to chronically ill or incapacitated patients in the community setting. The items intended for inclusion in the scheme are consumable, single use, non-implantable medical products, together with the hardware that the consumables are used with, essential to maintain an acceptable quality of life of afflicted patients who without government subsidy would not have adequate access to life supporting medical technology.

At present many of these essential care items are either unfunded or, if funded, vary in availability and subsidy depending on the place where the patient lives. Some assistance is available from the Federal Government, other support is from State Governments. Some products are provided ex gratia by healthcare practitioners who understand the need of the patient for the benefit that can be gained from use of a particular product.

The following criteria are proposed for products to be listed on the ECL:

  • products are essential to the patient’s quality of life or survival, in all settings outside hospitals including the community setting and residential care
  • products should be capable of self administration or administration with the help of a carer or, if required, by a relevant healthcare professional (which would include home visiting nurses)
  • products must be safe and efficacious and, where regulated, included on the Australian Register of Therapeutic Goods (ARTG)
  • products are appropriate for prescribing in the community setting
  • products are clinically effective – required levels of clinical evidence will be higher where similar products have not been listed before or where a manufacturer or supplier seeks a higher price than for similar products already listed
  • the cost of the product is relative to its clinical effectiveness.

In general the products contemplated by the scheme can be characterised as aids for daily living that are for the critical care of a patient or that improve the quality of a patient’s life. These will often be consumable items that are low technology. In some cases however they may be durable products, and may involve much higher levels of technology sophistication. The product range will also include the hardware that is supported by the consumables.

Products identified in an initial scope of the scheme include:

  • Oxygen supplies/consumables
  • Compression hosiery, bandages and garments for lymphodaema
  • Continence products
  • Modern wound care devices (including wound dressings)
  • Breast prosthetics (non-implantable)
  • Pumps and consumables for insulin delivery, and continuous flow pumps for drug delivery, together with consumables
  • CPAP/sleep apnoea devices
  • Laryngitic products
  • Diabetes consumables (pens, strips, pump consumables)
  • Home dialysis devices, consumables and set-up costs