Category: Patients

The industry body said calls made last year by Hearts4Heart, the peak patient group for AF that released a White Paper in Parliament House calling for an end to the political wrangling that leaves thousands of Australians languishing on public hospital waitlists for this lifechanging treatment.

Currently privately insured patients are generally not eligible for this treatment because the Prostheses List (PL) does not require reimbursement of non-implantable devices by private health insurers.

The MTAA called on the private health insurance industry to support this life saving and cost-effective treatment to be listed on the PL.

In October last year, MTAA signed a four-year Agreement with the Commonwealth that will deliver $1.1 billion in benefit reductions paid by private health insurers for medical devices. One of the key reforms in the Agreement is to review ways of listing non-implantable medical devices like catheter ablation for atrial fibrillation.

The industry believes the PL has not kept pace with advances in medical technology resulting in devices like catheter ablation not being eligible for listing because they are not permanently implanted in the body.

AF is a major public health issue affecting around 460,000 Australians, with up to 30% remaining undiagnosed. Further, it is also associated with a 5 to 7-fold increase in the risk of stroke and a 3-fold increase in the risk of heart failure.[1]

Today, AF is considered a major cause of stroke in Australia (6,000 strokes annually), heart failure and hospitalisation (more than 60,000 hospitalisations annually), with direct annual healthcare costs of approximately $1.63 billion.[2]

Ian Burgess, Chief Executive Officer of the Medical Technology Association of Australia said:

“This report supports our calls for non-implantable devices like catheter ablation being fast-tracked to the Prostheses List.

“The medical device sector has played its part in reducing healthcare costs by helping to deliver the lowest private health insurance premium increase in 17 years.

“But the current Prostheses List while successful in supporting choice and containing costs has not been updated to reflect advances in technology and models of care.

“The Prostheses List is a benefit to private health insurance members that ensures no out of pocket costs for medical devices.

“We believe access to a full range of medical technology is the most valuable component of a private health insurance policy and enables the medical device industry to do what it does best – assist patients lead healthier and more productive lives.”

[1] Ball J, Thompson DR, Ski CF et al. Estimating the current and future prevalence of atrial fibrillation in the Australian adult population. Med J Aust 2015; 202:32–35. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37: 2893–62.

[2] PricewaterhouseCoopers. Update: The economic cost of atrial fibrillation in Australia. 2017.

The Agreement signed in October 2017 will save private health insurers $1.1 billion in payments for medical devices over the next four years.

The industry association said it welcomed additional powers to the Private Health Insurance Ombudsman (PHIO) to conduct audits of private health insurers. This is a result of MTAA’s calls for such audits and will ensure private health insurers meet their obligations, including passing on every dollar of the $1.1 billion in saving for medical devices.

However, these cuts are significant and will impact on jobs and investment in the medical technology industry.

Despite the premium average due to increase by 3.95% – double the inflation rate – private health insurance companies will be slugging its 13.5 million customers with an additional $200 increase on a family policy come 1 April.

MTAA said it predicted this increase back in November 2017

At a time when the private health insurance sector showed a record $1.39 billion in net profit across the industry, an increase of 11.55% from the previous year.

Surely, there is scope to pass some of that back to customers through reduced premiums, rather than seeking a $200 premium increase.

The MTAA argues that the increasing profits of private health insurers would indicate they should do some belt tightening of their own to keep premium growth at the current inflation rate of 1.9%.

Ian Burgess, Chief Executive Officer of the Medical Technology Association of Australia said:

“Today’s announcement delivers the lowest premium change in 17 years, which can be attributed to the $1.1 billion in savings from the medical device industry.

“MTAA strongly supports the need for a healthy and viable private health insurance sector in Australia.

“But we’ve always maintained that given we represent 10% of private health insurers overall costs a reduction in costs for medical technology would only ever result in a modest reduction in premium increases.

“Unfortunately, it seems the private health insurance industry is asking others to reduce their costs to fund a reduction in premium growth but are reluctant to look to their own books for savings.

“Further, the private health insurance industry should embrace an expansion of the Prostheses List and enable faster access to private market as this will benefit patients and greatly increase the value proposition to its 13.5 million customers.”