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New Prostheses List Advisory Committee could reduce private insurance costs

12 September 2016 - 9:56am

The new Prostheses List Advisory Committee (PLAC) has now been announced on 8 September, formed with the intent to help Australians gain better value for money from their private health insurance. 

This new committee, formed as part of the Coalition government's broader private health reform agenda, has been lauded by Minister for Health Sussan Ley as a necessary first step towards improving accessibility and value for patients.

"The number one focus for the new PLAC will be to improve affordability and access to medical devices for consumers. The PLAC will also improve the transparency of the listing process and reduce duplication with the TGA's assessment processes," she explained.

For those who rely on their private health insurance to foot the bill of such procedures, this review will come as a welcome addition to the other reforms currently in play.


Prostheses come in many shapes and forms.Prostheses come in many shapes and forms.

What is the Prostheses List?

"We've been advocating for change to the Prostheses List for some time because of the unfair excessive cost it places on our members."

The Prostheses List is a selection of implanted devices, human tissues items and other such medical items which private health insurers pay benefits for when they are provided to a patient with the correct cover. 

However, the prices that are set out in the List are, according to some health insurers, significantly overinflated compared to other health systems.

"Australians with private health insurance are being forced to pay significantly more for hip and knee replacements, for example, than other patients because of this current regulatory failure," explained Medibank Managing Director George Savvides.

"We've been advocating for change to the Prostheses List for some time because of the unfair excessive cost it places on our members."

Changing the costs for insured persons

Medibank estimates that a change in the way that the Prostheses List is handled could save consumers $800 million.

The average Australian is spending about 33 per cent more on their health insurance now than they were 10 years ago, according to the Household, Income and Labour Dynamics in Australia Survey from the Melbourne Institute. That alone is a significant enough change, but add additional unnecessary prostheses costs to that, and this could inflate even further. 

According to Medibank, some prostheses currently on the List have a price more than double that which should reasonably be paid. An implantable cardiac defibrillator, for example, costs Western Australia Health $19,000, while the benefit for it on the List is $52,000: A significant difference that puts the patient on the receiving end.

Ironically, it is the people paying for private health insurance that end up having to pay more in some instances, with Medibank highlighting the fact that identical prosthesis products in the public sector can be 45 per cent cheaper than in the private sector.

Overall, Medibank estimates that a change in the way that the Prostheses List is handled could save consumers $800 million.

An expert panel

The new committee itself will be headed by Professor Terry Campbell, the Professor of Medicine at the University of New South Wales and Head of the Department of Medicine at St Vincent's Hospital. Other members will have expertise in clinical practice, health insurance, consumer health, health policy, private hospitals, health economics and, of course, the medical device industry.

The PLAC will also be supported by the Clinical Advisory Group, the panel of Clinical Experts and the Health Economic Subcommittee - making it a significant undertaking that will hopefully have equally significant ramifications for the medical devices and health insurance industries. Combined with the Medicare review that is currently underway, this new PLAC could mean major changes for the way you receive medical treatment in Australia.

For the time being, however, the List remains the same. If you are interested in finding health insurance that covers your needs for prostheses, make sure you get in touch with the team at HICA on 1300 44 22 01, or discover your health insurance comparison options online.