Prothesis list

To find consumer-specific information on private health insurance cover for prostheses go to the Private Health Insurance - Cover for Prostheses page.

prostheses list march 2019

To help keep private health insurance sustainable, the Agreement included benefit reductions for a range of categories on the Prostheses List. The list is aimed at Private Health Insurers, prostheses device manufacturers and other sponsors.

The IWG operated between January and March and was established to examine opportunities for reform of the arrangements governing prostheses and pricing in the private health insurance sector.

Prothesis list

Successive reviews have consistently raised similar issues suggesting that there are a number of challenges to reform. The committee heard that consumers are often unaware of the costs or rebates associated with the device chosen for them by their surgeon. Cardiac ablation catheters for treatment of atrial fibrillation were the first to be included on the List under this initiative as of 1 March This reform process has already delivered significant savings to private health insurers. There are approximately 11, items on the Prostheses List. Privately insured patients in public or private hospital settings are provided with prostheses that are: chosen by their surgeon or other relevant specialist; purchased by the hospital in which they are being treated; and paid for by a private health insurer at benefit levels recommended by a committee appointed by the Minister for Health. The Prostheses List is the list of surgically implanted prostheses, human tissue items and other medical devices that private health insurers must pay benefits for when: they are provided to a patient with appropriate health insurance cover they are provided as part of hospital treatment or hospital substitute treatment, and there is a Medicare benefit payable for the service. Identify the best application strategy, device grouping, and clinical data requirements. The department advised the process for determining the benefit levels: Prostheses for use in hip and knee replacement surgery, intraocular lenses and cardiac defibrillators, pacemakers and stents were clinically assessed and their benefit amounts negotiated with their respective sponsors. Compile applications and attachments, and submit on your behalf. Devices on Part A also must be approved for use by the Therapeutic Goods Administration and assessed for effectiveness and cost against other products by the Prostheses List Advisory Committee before they can be listed. Private hospitals and doctors 2.

The Prostheses List in Practice Introduction 2. The device must be surgically implanted in the body or enable another device to be implanted or allow an implant to continue to function after surgery.

Prostheses list 2019

Part B covers products that are derived from human tissue for treatment of a condition. Privately insured patients in public or private hospital settings are provided with prostheses that are: chosen by their surgeon or other relevant specialist; purchased by the hospital in which they are being treated; and paid for by a private health insurer at benefit levels recommended by a committee appointed by the Minister for Health. The committee heard that consumers are often unaware of the costs or rebates associated with the device chosen for them by their surgeon. Successive reviews have consistently raised similar issues suggesting that there are a number of challenges to reform. Request Information from our Specialists All fields are required unless specified. The Agreement also sets out a workplan to improve processes for listing products on the Prostheses List. Price differences 2. Figure 2. Prostheses Benefit Reductions On Friday 13 October the Minister for Health announced that the minimum benefits payable by private health insurers for devices on the Prostheses List would be reduced.

History of reform Introduction of the Prostheses List 2. These reforms came into effect on 20 February

Prothesis list

The Prostheses List is the list of surgically implanted prostheses, human tissue items and other medical devices that private health insurers must pay benefits for when: they are provided to a patient with appropriate health insurance cover they are provided as part of hospital treatment or hospital substitute treatment, and there is a Medicare benefit payable for the service. These changes came on top of benefit reductions of 7. In fact prostheses prices have not risen in real terms in the past seven years. History of reform Introduction of the Prostheses List 2. Demand for prostheses has been growing due to population ageing, chronic health conditions and the introduction of new technology. Cardiac ablation catheters for treatment of atrial fibrillation were the first to be included on the List under this initiative as of 1 March Our team in Sydney can help with Prostheses Listing applications Our consulting team in Australia has extensive experience preparing PL applications. Private hospitals and doctors 2. Part A is divided into 13 major categories according to the broad conditions they address, and is further divided into sub-categories, groups and sub-groups. The Australia Prostheses List PL identifies implantable devices eligible for reimbursement from all private health insurance funds. Table 2. The Prostheses List in Practice Introduction 2. The government regulates private health insurance through a range of legislative instruments, including the Private Health Insurance Act and, of particular interest to this inquiry, through the Private Health Insurance Prostheses List Rules.
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