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PHA calls for prostheses pricing reform

The private healthcare industry has called on the Federal Government to reform prostheses pricing, claiming Australians pay too much compared with overseas consumers.

In a submission to a private health cover review, Private Healthcare Australia (PHA) Acting CEO Steven Fanner says domestic and international price benchmarks suggest that, on average, the Australian private health system pays nearly twice the efficient benefit level for prostheses.

He says regulatory conditions have driven and entrenched highly inflated prices, and the current price-governance model is flawed.

“Prostheses benefits payments comprise 14% of total reimbursements by private health insurers and current pricing mechanisms for prostheses have led to benefit levels that are often twice as high as prices in comparable systems, both domestically and overseas.

“There is an imbalance between who benefits and who pays, with the value tilted heavily towards the multinational manufacturers at the expense of Australian consumers and taxpayers.”

PHA has suggested reforms to alleviate pressure on the public health system and save $800 million in annual healthcare expenditure, Mr Fanner says.

Pricing reforms would also contribute to a more efficient health system, leading to improved patient outcomes, he says. Any change should take into account quality of care, affordability and cost transparency.

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