HTA for reimbursement
Public and private funding programs using HTA to inform listing decisions
Australian Government funding programs that do not utilise formal HTA
A sponsor or manufacturer may seek to have a health technology assessed by the Australian Government for public funding under the Pharmaceutical Benefits Scheme (PBS), the National Immunisation Program (NIP) and the Medicare Benefits Schedule (MBS) and for private health insurance funding under the Prostheses List. The choice of funding program is dependent on the nature of the health technology (that is, whether it is a medicine, a medical procedure, diagnostic test or a medical device). Where a health technology is co-dependent (for example, a drug/test combination) it may need to be considered for eligibility under two or more of these funding programs.
HTA for reimbursement assesses health technologies in regard to their comparative clinical effectiveness and cost effectiveness. This aims to ensure that taxpayers’ money is used to support the health care interventions that achieve the maximum health improvement at the lowest cost.
Current health technologies assessed include: medical services, surgical interventions, medical procedures, diagnostic technologies (including pathology), medical devices, vaccines and pharmaceuticals, as well as combinations of these health technologies including hybrid and co-dependent technologies.
Public and private funding programs using HTA to inform listing decisions include:
- Pharmaceutical Benefits Scheme (PBS)
- National Immunisation Program (NIP)
- Medicare Benefits Schedule (MBS)
- Prostheses List
- National Blood Agreement
Applicants seeking funding under any of these programs are encouraged to review the relevant websites which are linked to this website prior to making an application, or to contact the appropriate secretariats.
Where the government decides not to reimburse a new technology it will remain available on the Australian market as long as it is included on the ARTG.
Completion of an HTA for reimbursement process results in advice to the government (usually to the Minister for Health and Ageing). The final decision about which health technologies should be reimbursed cannot be reduced to a formula. The Australian Government, as the decision-maker, consider a number of factors when deciding subsidies for health technology. This includes differing, and sometimes conflicting, community views on the relative importance of a particular technology or intervention; the characteristics and size of the patient group affected; the severity or impact of the disease being treated; and the availability of effective alternative treatments. In addition, the government must make judgements about the total amount of funding for health care, taking into account other priorities for the Australian community.
Australian Government funding programs that do not utilise formal HTA
In addition to the Pharmaceutical Benefits Scheme (PBS), the Medicare Benefits Schedule (MBS) the Prostheses List, the National Blood Agreement and the National Immunisation Program (NIP), the Australian Government funds a range of programs for the purposes of providing subsidised health technologies to Australians. For example, the National External Breast Prostheses Reimbursement Program and the National Diabetes Services Scheme (NDSS) are two of these programs. However, because HTA processes are not employed in the administration of these programs, they are not within the scope of this website.Further information about these programs
Top of page
Page currency, Latest update: 16 September, 2010
