First stage of prostheses benefit reform commences

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The Department of Health has commenced work to reform prostheses benefits, with a research and design project as a first stage in developing in benefit setting framework for prostheses. The Project is being managed by the Department with guidance from the Prostheses List Advisory Committee.

The Department’s project team will engage directly with the peak bodies and AusBiotech has been confirmed as a ‘Stakeholder Representative Organisation’, which will receive member feedback and submit by 21 December 2016.

The Department has engaged the University of Melbourne’s Centre for Health Policy to research pricing models for medical devices and develop options for the design of frameworks for prostheses benefits within the Australian private health setting.

This project leads on from the Industry Working Group on Private Health Insurance Prostheses Reform and its final report (March 2016), which set out a number of areas for improvement and potential change.  One such area is to create a more competitive basis for purchase and reimbursement of prostheses, including consideration of options for new pricing mechanisms.

The project team is requesting information on the current arrangements on supplying, purchasing and reimbursing medical devices, including the consideration of innovative approaches that may support:

  • a more competitive and value-for-money basis for purchasing and reimbursement;
  • improved transparency in benefit setting for a device, taking into consideration appropriate costs for inclusion in the benefit (eg. clinically relevant requirements, such as:  in theatre assistance, software, maintenance, monitoring, and product support, etc.); and
  • timely access to a reasonable choice of prostheses.

AusBiotech members are invited to submit comments by 19 December 2016 to Helen Arthur, National Programs Manager (, 03 9828 1425), or directly to the Department by emailing