The Australian Minister of Health, the Hon Sussan Ley MP has announced a wide ranging review into Private Health Insurance in Australia. This is in addition to the review of the Medical Benefits Schedule. (http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSReviewTaskforce)
The review is likely to be of great significance to companies who supply medical technology to the Australian market. Private Health Insurers in Australia are highly regulated and are currently only permitted to cover services delivered in hospitals and ancillary services such as dentistry and physiotherapy. This contributes to the somewhat fragmentary nature of the Australian health financing system, particularly as it relates to devices. See https://medtechnique.com.au/wp-content/uploads/2015/05/Read-More.pdf for more detailed information
The current system can be either a blessing or a curse for medical technology innovators. If you are marketing a device that is implantable and meets the criteria for inclusion on the ‘Prostheses List’ (http://www.health.gov.au/internet/main/publishing.nsf/Content/health-privatehealth-prostheseslist.htm) then the status quo is likely to be advantageous to you. If your device falls outside these arrangements then marketing some devices can be somewhat problematic and any change to regulations may represent an opportunity.
The current Australian Government has a predilection for deregulation. The current review is ostensibly to ‘amend unnecessary or inefficient regulation which add costs for consumers; and identify reforms which would enhance the value of private health insurance’ http://www.health.gov.au/internet/main/publishing.nsf/Content/PHIconsultations2015-16
However the government runs the risk of reducing the attractiveness of private health insurance if the clinical choices that are currently available under private health insurance to doctors and other providers are diminished in order to increase ‘efficiency’. If the differentiating factors between the public and private systems are reduced then it will be harder to encourage Australians to invest in private health insurance.
In terms of medical technology, any possible deregulation will likely represent a mixed bag of risk for companies and new opportunities for companies that can demonstrate clinical and economic benefits to insurers.
For information on reimbursement and market access for medical devices and procedures in Australia, please see www.medtechnique.com.au