Media releases

May 3, 2016


Medibank welcomes the Federal Government’s commitments in the 2016-17 Budget to improve affordability and value of private health insurance for Australians, and to reform prostheses pricing.

“Currently, Australians with private health insurance are being forced to pay significantly more than other patients for prostheses devices, and we’re pleased the Government is serious about addressing this regulatory failure,” Medibank Acting CEO, David Koczkar, said.

The Prostheses List sets out minimum reimbursement levels for 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 as part of hospital treatment or hospital substitute treatment, and there is a Medicare benefit payable for the professional service.

However, the prices currently set out in the List are highly inflated compared to similar health systems both domestically and overseas.

The Government has announced in the 2016-17 Budget that the Prostheses List Advisory Committee will be refocused to deliver better value for consumers.

“We expect that the Committee will advise the Government that pricing benchmarks should be introduced so that private patients pay a fair amount for prostheses,” Mr Koczkar said.

“This will make it fairer for Australians with private health insurance and the savings will reduce pressure on premiums.”

Prostheses make up 14 per cent of the costs paid by private insurers to hospitals. In FY14, the industry paid approximately $1.75 billion for prostheses items.

The Government also announced in the Budget that it will establish a Private Health Sector Reform Committee to advise on the design and implementation of private health insurance reforms.

“There is certainly a lot that can be done to improve the affordability of private healthcare, including the value of private health insurance, and we look forward to working with the Government to achieve this,” Mr Koczkar said.

Medibank has proposed a number of reforms to improve affordability and value of private health insurance, including improving information-sharing for consumers and insurers, standardising simpler products and terminology, ending cost-shifting from public hospitals to privately insured consumers, and improving competition and premium setting.

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