New data shows that government regulators are being outfoxed, with millions of Australians faced with paying far too much for medically implanted devices or prostheses.
Data matching by Members Health shows that in 2022/23, some medical device manufacturers charged private patients up to 65% more than those in public hospitals.
The Government data reveals that a cardiac defibrillator (AICD) can cost $25,630 more for private patients. A spinal fusion can come in at over $18,065 more. A pacemaker can cost $7,111 more. Those paying for a hip replacement can be stung for over $2,600 more than public patients.
“The data points to regulatory capture by special interests and a dire need for reform,” said Matthew Koce, CEO of Members Health, the umbrella body for Australia’s not-for-profit and member-owned health insurers.
“If private patients were charged public sector prostheses prices, the private sector could save up to $1 billion a year, based on current patient volumes.”
“The high price of prostheses is yet another a slap in the face for Australians experiencing unprecedented cost of living pressures.”
“These are the same prostheses devices used in the same country, for the same procedures. The only difference is that the one used in a private setting comes with a much much bigger price tag attached to it for the patient.”
“Members Health is calling on the newly re-elected Albanese Government to take action and make prostheses reform a priority for their second term of office.”
“To deliver savings to consumers and make the system fair, Members Health is calling on the Albanese Labor Government to immediately do three things.”
“Firstly, put in place a continuous process of domestic and international price benchmarking.”
“Secondly, legislate mandatory price transparency so that the public can have confidence that prices are fair. This would put in place regulation that is aligned to the highly successful price transparency enshrined for PBS-listed pharmaceuticals.”
“Thirdly, explicitly ban and put in place harsh penalties for under-the-table rebates, financial incentives and kickbacks between device manufacturers and third parties, such as hospitals and clinicians.”
“These three simple and obvious reforms would immediately deliver big savings for Australian consumers with private health insurance.”
“Over the longer term, what is needed is the establishment of a National Prostheses Purchasing Authority to centralise procurement for all public and private hospitals. In France a national approach has proven highly effective in driving down prostheses prices and administrative costs for both public and private hospitals.” Mr Koce said.
“The current regulatory system for prostheses has failed Australian consumers and is not sustainable. Inflated prices suggest the brazen exploitation by big overseas dominated conglomerates out to fatten their bottom line at the expense of patients.”
“There can be no legitimate justification for Australians having to pay up to 65% more for some medical devices, just because they are a private patient. It is both unfair and it is wrong.”
“Australians can be assured that any savings achieved from prostheses reform will be passed on to them by the 24 Members Health funds, who always put people first, not profits.”
Members Health is the peak industry body for an alliance of 24 health funds that are not-for-profit or part of a member-owned group, regional or community based. They all share the common ethic of putting their members’ health before profit. Our funds represent the interests of more than 5.4 million Australians.
Media Contact
brenton.baldwin@membershealth.com.au
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