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500 surgical consumables to be covered under new funding arrangement

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Private health insurers and hospitals are set to receive a new funding arrangement for around 500 surgical general use and consumable items.

The default benefits for these items, which include sutures, haemostatic agents and skin glues, will be mandated through changes to the Private Health Insurance Act (Benefit Requirements) Rules 2011. This will clearly define the benefits insurers must pay to hospitals when these items are used in surgery for private patients.

The individually listed items will be removed from the existing Prostheses List, which sets the benefits for implantable devices and items for private patients.

The Independent Health and Aged Care Pricing Authority (IHACPA) has provided advice for the bundling of these items, which will provide clear information for insurers and hospitals, while also simplifying the Prostheses List.

These changes will go into effect on 1 July 2023 and will ensure that private patients continue to have access to these important items.

The Clinical Implementation Reference Group has confirmed that there will be no clinical implications or adverse outcomes for patients, as these items will still be available under the new funding arrangement.

The reforms to private system prices for surgical devices are intended to better align them with those paid within the public health system and comparable international markets. The changes will not affect the overall benefits paid by insurers, as IHACPA used utilisation trend data to develop its advice.

Minister for Health and Aged Care Mark Butler said, “These general use and consumable items are the kind that could be used in any surgery performed in Australia, and the inclusion of separate entries for each on the Prostheses List appears to have been contributing to inflated costs for private patients.

“Insurers will be mandated to fund General Use Bundles, which means private patients will not face additional out of pocket costs for these consumables when they have surgery.

“The Government’s priority is that Australians access affordable medical devices and that the taxpayer gets value for money, both in the public system and through our support for private health insurance,” Butler said.

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