Costs an arm and a leg

Health fund members face out-of-pocket rises

HEALTH fund members could face exorbitant out-ofpocket expenses for devices such as hip and knee replacements, stents and pacemakers under major reforms being considered by the federal government.

And from 2022, surgeons could also be stopped from selecting the best medical devices to treat their patients, product manufacturers claim.

At present, health funds have to reimburse the full cost of any medical device on the government’s prostheses list, but Australians are massively overcharged.

Private patients pay double the price of those overseas and 45 per cent more than public hospitals. The changes have been proposed by the Department of Health and private insurers ahead of the May budget, which could see an average price set for medical devices.

Health funds would have to pay only the new average price, so if patients or surgeons being chose a more expensive device the patient might have to find the extra, out of their own pocket.

An 2019 IPSOS study for the government found half of all private hospital patients already pay a gap fee of about $1000-$2000 for surgeons’ expenses. Any new medical device gaps would come on top of these.

Health funds are backing the changes, which they claim would save members $500m and stop health fund premiums rising by at least 1 per cent.

The device proposal would also take the pressure off government subsidies for private health insurance.

However, the Medical Technology Association of Australia said “the choice of medical devices could end up being dictated by private health insurance providers, with no input from healthcare professionals”.

The private health system would “mirror the public system, which greatly limits choice and focuses on using the cheapest items – this is not what health insurance members sign up for,” MTAA chief executive Ian Burgess said.

Private Healthcare Australia denied patients would face higher gap fees as a result of the change.

“There will be no co-payments, we’re absolutely upfront about that,” PHA chief executive Dr Rachel David said. However, she said doctors who wanted to use more expensive devices could organise to purchase them for their patients and they would receive the health fund rebate normally paid to the hospital.

Medicare legal expert Margaret Faux said doctors could easily build the extra charges to cover for higher device prices into a booking fee or higher consultation charges.

Australian Medical Association president Dr Omar Khorshid said there needs to be reform, but rejected the average price model.