2016 is shaping up to be ‘interesting’ for those companies supplying medical devices into the generally profitable and stable Australian market.  A federal election will be held sometime this year with health funding in general sure to be a major area of debate.  Specifically, a number of federal government reviews are underway, the two most significant being the Review of Private Health Insurance and the review of the Medical Benefits Schedule. Both reviews have received significant publicity.

The Private Health Insurance review will almost certainly recommend some reform of the current ‘Prostheses List’ system which guarantees suppliers a specific benefit for implantable devices for privately insured patients.  What precise changes will be recommended is unclear as yet.

The Medical Benefits Schedule (MBS) is the list of medical procedures which are subsidised by the Australian Medicare System.  The review is intended to modernise the MBS by removing obsolete procedures or those not supported by clinical evidence.  However, the cumbersome process of listing new procedures is not included in the review.  The review is likely to provoke further uproar as specific recommendations impact on interest groups.

In addition, a review of the Medical Services Advisory Committee (MSAC) processes is currently underway with the initial proposals recently made public. https://consultations.health.gov.au/mbd/msac-reforms-call-for-public-comment/consult_view.   MSAC is the body that makes recommendations on the clinical and cost effectiveness of new medical procedures and recommends whether they should be included on the MBS.  The process is lengthy, expensive and is often criticised for lack of transparency and excessive bureaucracy.  The proposed new process still appears extremely complex but may offer an expedited pathway in some circumstances.

For advice on reimbursement of medical devices in Australia, please see www.medtechnique.com.au