Prostheses List Reform

Key points

  • MTAA Agreement with Government delivering $1.1 billion in savings on the Prostheses List
  • This delivered the lowest health insurance premium increase in 18 years this year

In October 2017, MTAA entered into an Agreement with the Australian Government for reforms to the Prostheses List.

To help keep private health insurance sustainable, the Agreement included benefit reductions for a range of categories on the Prostheses List.

The reductions are estimated to save private health insurers $1.1 billion over 4 years from 2018. As a direct result of these savings, the private health insurance premium increase in 2019 was the lowest in 18 years.

These changes came on top of benefit reductions of 7.5-10% already implemented in February 2017 to 5 major prostheses categories.

The Australian Government agreed not to further change benefits on the Prostheses List until 31 January 2022 without agreement from the MTAA.

The Agreement also sets out a workplan to improve processes for listing products on the Prostheses List. This includes moving from two to three listings a year, which is being implemented in 2019.

There was also an agreement to consider ways of listing new targeted medical devices on the Prostheses List that do not meet the current criteria for listing, but are safe, clinically effective and cost effective. Cardiac ablation catheters for treatment of atrial fibrillation were the first to be included on the List under this initiative as of 1 March 2019.

Other key areas of the workplan include:

  • Reducing the time to list by streamlining processes for Prostheses List applications
  • Establishing new process for benefit setting and review to better recognise value and innovation of prostheses
  • Improving the transparency of listing processes
  • Introducing a new model for recognising superior clinical performance (SCP) in prostheses by 1 February 2022
  • The Australian Government to support Australian medical technology innovation by establishing a $30 million med-tech and biotech grants program for SMEs

The workplan under the Agreement is ongoing and includes stakeholders from private health insurance, private hospitals, consumer organisations, independent experts, the Department of Health and the MTAA.

This reform process has already delivered significant savings to private health insurers. Industry needs a stable, predictable pricing environment to continue to deliver health benefits for Australians.

MTAA has called on the Government and Opposition to respect the terms of the Agreement following the 2019 federal election

MTAA Site Links:

About the Prostheses List
Listing on the Prostheses List
MTAA submission to Senate Inquiry on the Prostheses List