Author: Team

PRICE DISPARITY BLAMED FOR HIGHER PREMIUMS

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[vc_row][vc_column][vc_column_text]Just last month, the Guardian reported that the Australian competition watchdog’s review of the private health insurance industry found Australians were forced to cough up $23.9 billion in premiums last financial year – that’s $834 million more than they had to pay in 2016/17.

The Guardian also reported that “the number of people with hospital-only or combined health cover fell 0.9 percentage points to 45.1%, while the proposition of policyholders with extras-only cover rose to 9.2% from 8.9%”.

The association representing Australia’s private health insurance industry, Private Healthcare Australia (PHA), has continued to assert that private health funds are delivering record health benefits for Australians, despite their decision to increase premiums for their customers.

PHA has points to a number of factors for the price hikes, including blaming medical technology (MedTech) innovators for the prices they charge for medical devices. However, PHA appears to have conveniently ignored the Agreement MedTech innovators reached with the Commonwealth Government to deliver $1.1 billion in savings, over four years. This enabled MedTech innovators to singlehandedly deliver, for Australians, the lowest increase to their private health insurance premiums in 17 years.

Another tried and tested argument rolled out by the PHI industry is that Australians are charged up to three times more for medical devices than their British and New Zealand counterparts. MedTech innovators, however, argue that the variations in prices for medical devices reflects the differing market environments, supply chains, economies of scale and contrasting reimbursement systems from country to country.

So do Australians really pay more for the same devices? Let’s take a look:

In 2016, one of Australia’s largest PHI companies, Bupa, acknowledged the difficulty in comparing the prices of devices in one country to another. When asked why Australians are having to pay up to $400 more a month for private health insurance than consumers in countries like Britain, Bupa said the “private health market in Britain was ‘very different’ (than Australia’s market), with insurers able to pick and choose customers and force patients to seek their approval before being referred to a specialist.”

The structure of healthcare systems in individual countries, the split between private and public healthcare and the source of funding impacts the price of prostheses, making it impossible for prices to be the same across different countries.

A simple example of these difference can be found when comparing the incentives for the public hospital sector and the private hospital sector and the services they provide. Public hospitals are incentivised to provide necessary and efficient care at the lowest possible cost through, what is called, Activity Based Funding (ABF). As a result, purchasing of prostheses occurs through centralised tenders which trade off prostheses choice against prostheses volume (either directly or indirectly), with control about what is available to the hospital being made by hospital administrators.

The private hospital sector, however, is not constrained by ABF and clinicians rather than hospital administrators make the decisions about services and care provided, including the types of prostheses they would like to use. These different incentives influence the different patterns of use and the economies of scale that are possible.

So, while some countries may appear to have comparable healthcare systems to Australia, but when they are analysed in a greater depth, they can actually be completely different.[/vc_column_text][/vc_column][/vc_row]

$240 MILLION FOR RESEARCH INTO THE NEXT BIG MEDICAL BREAKTHROUGH

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[vc_row][vc_column][vc_column_text]Applications for the Frontier Health and Medical Research program have now opened, allowing researchers to push the boundaries to develop tomorrow’s health and medical breakthroughs.

The Frontiers program is filling a gap in the research sector by providing government funding for early innovative projects and ideas that traditionally would not have received funding at this stage.

The Australian-first program has a unique, two-stage structure and was developed in consultation with Australian and international leaders in health and medical research including Research Australia.

In stage one, up to ten selected applicants will receive funding of up to $1 million each over one year to develop detailed planning for their cutting-edge research projects.

In stage two, a number of research plans developed under stage one will be chosen to receive funding to develop their ideas into new technological advances or approaches to revolutionise healthcare.

Stage two grants could be $50 million or more depending on the project and can extend over five years.

This program will confirm Australia as a leading source of innovation and discovery and will help bring about the next big medical breakthrough.

Frontiers is an initiative under the $1.3 billion National Health and Medical Industry Growth Plan, announced in the 2018 Budget. This game changing program is funded by the Government’s Medical Research Future Fund (MRFF).

Minister Hunt said the investment has the potential to transform healthcare and stimulate growth in the Australian medical technologies, biomedical and pharmaceutical (MTP) sector, a vital part of the innovation economy.

“The Government is able to provide unprecedented levels of support to health and medical research because of our strong economic management,” Mr Hunt said.

The MRFF is an endowment fund, which will mature at $20 billion, providing a sustainable source of funding for vital medical research. It is the single largest boost in health and medical research funding in Australia’s history.[/vc_column_text][/vc_column][/vc_row]

KENEALLY’S STILLBIRTH STORY BRINGS TEARS

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[vc_row][vc_column][vc_column_text]Senator and former NSW Premier Kristina Keneally has been a strong advocate for removing the stigma around stillbirth, having paid tribute to her stillborn daughter, Caroline, in her maiden speech before the Senate earlier this year. Senator Kenneally, who had been a driving force behind the inquiry, was given another opportunity to discuss the issue this week in the Senate as the Select Committee on Stillbirth Research and Education tabled its long-awaited report. Most significantly, the report brought to light the reality that six babies are stillborn daily in Australia. According to Senator Kenneally, part of the high rate has been an apprehension on the part of the public to discuss and share their experiences and insights of a particularly traumatic event in the life of parents and families. In Senator Kenneally’s words: “we have considered stillbirth too sad to talk about.”

When the report was handed down in the Senate, Senator Keneally was moved to tears as it became apparent that stillbirth was now part of a conversation leading to better health outcomes, better emotional support and better community awareness. She took the moment to recognise the names of the children who had been lost and the bravery of their parents who had shared their personal experience of stillbirth with the inquiry. Poignantly, Senator Keneally highlighted that the report would be “part of their legacy”. In tabling the report, Northern Territory Senator Malarndirri McCarthy also took the opportunity to acknowledge the work of Senator Keneally in bringing the issue to the public’s attention.

The report found that 1 in every 137 women who reached 20 weeks of pregnancy would experience a stillbirth, a striking figure that Senator Kenneally argued was “significantly higher than in similar nations such as New Zealand, the UK, the Netherlands and the Scandinavian countries.” In fact, the Australian rate of stillbirths is more than a third higher than other OECD countries with the best birth outcomes.

Following an eight-month investigation, 268 submissions and six public hearings, the inquiry also heard about the trauma that continues outside of the hospital – with stories of women being made redundant from their jobs and other parents being told they were no longer entitled to paid parental leave.

The report made recommendations in three key areas: prevention, investigation and support. Critical activities in these areas will involve national education campaigns, continuity of care models, training for clinicians, changes to parental leave schemes and further investigation into stillbirths at the postmortem stage.

Health Minister the Hon Greg Hunt MP responded to the report with the announcement of a national roundtable – as well as an initial commitments of $7 million to medical research and education programs.[/vc_column_text][/vc_column][/vc_row]

A Finite Resource With Infinite Demands

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[vc_row][vc_column][vc_column_text]The Medical Services Advisory Committee (MSAC) plays an important role in determining which medical services Australians have access to through Medicare.  It may be stating the obvious, but funding for healthcare is a finite resource, and there are infinite demands for healthcare.  It follows that healthcare dollars must be spent judiciously.

MSAC is charged with deciding whether a new medical service should be publicly funded based on an ‘assessment of its comparative safety, clinical effectiveness, cost-effectiveness and total cost’.  Innovations in medical technology often require the development of new medical procedures to ensure that the technology can be utilised for its best possible performance.  MSAC decides whether a medical professional can be paid for performing the procedure. If the application is successful, the procedure will be included on the Medical Benefits Schedule (MBS). If the technology is implantable then the device will likely to be eligible to be included on the Prostheses List.

Some new technologies allow patients to be treated outside of a hospital.  Treatment for varicose veins has previously involved invasive procedures to be carried out solely in the care of hospitals.  Innovation in technologies such as radio-frequency ablation hasenabled patients to access these procedures in alternative, more office based environments.  The MBS covers payment to the doctor for performing the procedure but does not, in most cases, make an allowance for any single-use technologies.  This can result in significant out of pockets for patients.  MSAC has acknowledged this structural issue on a number of occasions in their assessments of new technologies.

This problem is compounded by our strange system of private health insurance (PHI). PHI covers hospital admissions but does not cover office-based therapies, therefore hospital-based treatments may be less expensive for patients, while overall costing more.  Looking at this from an economic perspective, we can see that the least costly options of out-patient based innovations are not being incentivised by the payment system.

There is certainly an opportunity for Government to have a more flexible approach to what may be included in an MBS fee. Realistic coverage for the actual cost of delivering a service, including device cost, would be of real benefit to patients and is likely to reduce the cost to the health system overall.  Alternatively, at a time when the value of PHI is certainly being questioned, mechanisms whereby PHI could cover out of hospital procedures – that the MSAC has previously considered to represent good value, should also be considered.[/vc_column_text][vc_zigzag][/vc_column][/vc_row][vc_row][vc_column width=”1/4″][vc_single_image image=”2606″ img_size=”full”][/vc_column][vc_column width=”3/4″][vc_column_text]

About The Author

Sarah Griffin B.App.Sc (Physio), GradDIp Health Ec & Policy
Principal Medtechnique Consulting.

Sarah Griffin is the founder of Medtechnique Consulting and has more than 25 years experience in medical technology, both in Australia and the United States. Sarah expertise includes health economics, health insurance, health policy and legislation, reimbursement systems and government relations. Sarah also serves as Chair of the AusMedtech Health Economics Expert Panel and as an independent expert to the Australian Government’s Industry Working Group on Prostheses List Benefit Reform.[/vc_column_text][/vc_column][/vc_row]

$23 Million Funding Boost For Peak Health Groups

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[vc_row][vc_column][vc_column_text]The Liberal National Government will provide the nation’s peak health groups and advisory bodies with $23.5 million over three years to help build a healthier Australia.

Organisations such as the Australian College of Nursing, the Consumers Health Forum, Lifeline and the Rural Doctors Association will receive funding through the Health Peak and Advisory Bodies Programme so they can continue to contribute engaged, robust and constructive participation.

Established in 2016, the Health Peak and Advisory Bodies Programme supports a wide range of organisations, and a total of 23 organisations have been provided funding over three years.

This will enable the organisations to play their part in informing the Government’s health agenda through impartial advice, thus contributing to improved health outcomes for Australians.

This can include consulting and sharing information with their members, the wider health sector, the community and the Government, providing sector knowledge and expertise and providing education and training to health practitioners to improve the quality of health services.

These organisations are integral to building a better health care system for the nation.

Their voices are important – and those voices wouldn’t be heard without the funding the Government provides under this program.

Several of these organisations also receive funding to deliver specific health programs under different funding streams. This funding is in addition to the Health Peak and Advisory Bodies Programme.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Organisation Name Total funding
Australian College of Nursing $1,125,000
Australian Federation of AIDS Organisations $1,125,000
Consumers Health Forum of Australia $1,125,000
Allergy and Anaphylaxis Australia $652,062
Allied Health Professions Australia $459,075
Asthma Australia $667,851
Australian Association of Practice Managers $622,866
Australian Healthcare and Hospitals Association $558,300
Continence Foundation of Australia $1,125,000
Haemophilia Foundation Australia $585,000
Heart Support-Australia $819,000
Hepatitis Australia $1,125,000
Lifeline Australia $525,000
Macular Disease Foundation Australia $1,125,000
Metabolic Dietary Disorders Association $537,000
Mental Health Australia $1,650,000
National Association of People Living with HIV/AIDS $1,125,000
National Rural Health Alliance $2,910,000
Palliative Care Australia $1,125,000
Public Health Association of Australia $1,125,000
Rural Doctors Association of Australia $1,125,000
The Pharmaceutical Society of Australia $1,125,000
Vision 2020 The Right to Sight Australia $1,125,000
Total HPAB funding $23,486,154

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MEDTECH MEDIA STORM, FAIR AND BALANCED?

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[vc_row][vc_column][vc_column_text]The campaign, coordinated by a U.S.-based media group, launched a barrage of negative stories that sought to question the safety and integrity of regulatory processes for medical devices around the world. Here in Australia, local media outlets used the opportunity to share the stories of specially selected patients who alleged their medical devices were not functioning as intended and questioned the robustness of Australia’s regulatory processes.

The association representing MedTech innovators in Australia, the Medical Technology Association of Australia (MTAA), was quick to slam, what it described as an “inaccurate and sensationalist” campaign adopted by Australian media outlets.

In a statement, MTAA CEO, Ian Burgess, voiced his disappointment at the irresponsible tone and the inaccuracies of the media coverage.

“It’s disappointing to see Australian media outlets, such as the ABC, calling into question the integrity of the TGA, MedTech innovators and the dedicated Australians who work in the industry, by choosing to go down the path of sensationalism and biased reporting,” Mr Burgess said.

As PulseLine covered last week in our feature story, Australia has one of the most highly regulated and robust assessment systems in the world for MedTech. Considering the millions of MedTech devices Australians have successfully implanted, or come into contact with each year, it’s hard not to see the regulatory process has a strong track record for safety.

If you’re asking yourself ‘doesn’t selective reporting by the media undermine the confidence people have in the system?’ You would be right.

Unbalanced stories, specifically orchestrated for coordinated media campaigns like this one, can create unwarranted fear in the community, causing someone, who would benefit from a medical device, to avoid seeking treatment that could otherwise improve their quality of life.

Following the media storm Australia’s federal Minister for Health, Greg Hunt, requested Australia’s regulator, the Therapeutic Goods Administration (TGA), to investigate whether additional measures are needed to improve the safety of medical devices.

While it is still too early to know what sort of harm this negative campaign will have on patients’ decisions to forgo the benefits of medical devices, one thing is for sure, Australian media outlets should avoid the pitfalls of the type of sensationalist reporting that is all too often common practice in other parts of the world.

Australians can, and should, be proud of the professionalism of the hardworking men and women who work in the TGA and the MedTech industry who work day-in and day-out to ensure Australians have access to the most innovative and life-changing medical technologies in the world.[/vc_column_text][vc_zigzag][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

DID YOU KNOW:

Global advances in medical technology over the past 20 years has led to a 56% reduction in hospital stays, 25% decline in disability rates, 16% decline in annual mortality and an increase in life expectancy of approx. 3.2 years?[/vc_column_text][/vc_column][/vc_row]

HOW ROBUST ARE AUSTRALIA’S REGULATIONS?

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[vc_row][vc_column][vc_column_text]When questions about safety are raised it’s understandable that people, by their nature, might assume the worst is true. But is it? PulseLine wanted to go to the source and find out just how robust Australia’s system is when it comes to medical devices.

In Australia MedTech companies are represented by a national association called the Medical Technology Association of Australia (MTAA). The aim of MTAA is to ensure the benefits of modern, innovative and reliable MedTech are delivered effectively to provide Australians with better health outcomes and an improved quality of life.

MTAA CEO, Ian Burgess, believes millions of Australians’ lives have been transformed by having a medical device thanks to the Australian MedTech industry making safety as its highest priority.

“MedTech has improved the lives of millions of people right across Australia, thanks primarily to the efforts made by MedTech companies, government and medical practitioners placing such a high priority on the safety of medical devices being used in Australia,” Mr Burgess said.

“When it comes to ensuring we have a robust and thorough process for approving medical devices for the Australian market, MTAA are the first to advocate for a consistent and evidence-based approach to regulations.”

In Australia, the regulatory process is governed by a risk-based system of classification that determines the level of scrutiny a medical device will be subjected to before it is included in the Australian Register of Therapeutic Goods (ARTG). A medical device must be on the ARTG before it can be lawfully supplied in or imported into Australia.

The regulator responsible for overseeing this process in Australia is the Therapeutic Goods Administration (TGA) which assesses medical devices in line with a device’s intended purpose and risk-based classification. This includes:

  • A pre-market assessment – called a conformity assessment;
  • Market authorisation – so the device can be included on the ARTG; and
  • Post-market monitoring – which ensures the device continues to comply with all of the regulatory, safety and performance requirements and standards.

We all know how fast technology changes in today’s world. So, when it comes to regulations keeping up with that change, we wanted to know what the MedTech industry and government were doing to keep pace.

It turns out that in 2016 the Australian Government announced a series of reforms and projects to improve the regulatory process. These include moving towards global harmonisation, achieving appropriate classification for classes of medical devices based on risk, and working with sponsors and manufacturers to manage emerging issues in the post-market space.

Department of Health Deputy Secretary, Adjunct Professor John Skerritt, highlighted to PulseLine that TGA uses a number of sources of information to monitor the ongoing safety of medical devices included in the ARTG.

When it comes to monitoring the safety of post-market devices, the TGA receives “signals from multiple sources including notifications and information from other regulators, compulsory reporting from manufacturers and sponsors, competitors and whistle-blowers, media and government,” Professor Skerritt said.

“Reporting of adverse events and issues associated with the use of medical devices plays a vital role in identifying emerging issues that may require regulatory action or legislation change.”

Medical devices in Australia are subjected to a robust regulatory approval and legal framework, which requires device companies to report adverse events to the TGA.

So, when you consider the millions of medical devices Australians have successfully implanted, or interact with each year, it’s clear the regulatory process has a strong track record for ensuring safety for all Australians.[/vc_column_text][/vc_column][/vc_row]