Health Insurance

Prostheses and Devices Committee (PDC)

The Prostheses and Devices Committee (PDC) was established by the Minister for Health and Ageing on 14 July 2004.

The Prostheses and Devices Committee (PDC) was established by the Minister for Health and Ageing on 14 July 2004 to provide advice on the listing of no gap and gap permitted prostheses and the benefits payable for them.

The 13 members of the PDC are nominees of the major stakeholders - the health insurers, private hospitals, clinicians, prostheses and medical device suppliers, consumer organisations and the Department of Veterans' Affairs.

Dr Bruce McPhee is the Chair of the PDC.

The role and maintenance of the PDC and its supporting committees, and the operating procedures of the PDC are now included as appendices to Part 1 of the Prostheses List Guide.

PDC Bulletins

The purpose of PDC Bulletins is to provide all stakeholders to the prostheses arrangements with information which may be relevant to them for the current and future Prostheses List cycles.

The Bulletins are provided below:
PDC Bulletins

Clinical Advisory Groups and Panel of Clinical Experts

The PDC has appointed Clinical Advisory Groups (CAGs) to evaluate groups of prostheses currently on the Prostheses List, to assess and compare their relative clinical effectiveness and/or relative clinical design, and sort the products into groups of similar clinical design and outcomes.

This process assists in determining the benefits that should be paid for different types of prostheses.

Members of the CAGs also clinically evaluate applications for new products to be listed.

There are eight CAGs:

• Cardiac prostheses - this includes stents, cardiac pacemakers and leads and cardiac defibrillators and leads;
• Knee prostheses;
• Hip prostheses;
• Ophthalmic prostheses;
• Vascular prostheses;
• Spinal prostheses;
• Urogenital prostheses; and
• Cardiothoracic prostheses. Top of page

The CAGs are comprised mostly of expert clinicians in their relevant field, nominated by the learned colleges and the Australian Medical Association. Clinicians have been chosen from across Australia to ensure the best possible representation of experience in surgery and the use of prostheses. In addition, each CAG has health insurer nominees, a non-aligned sponsor nominee, a consumer representative and Department advisors.

The PDC has appointed a Panel of Clinical Experts (PoCE). The PoCE assist with the clinical evaluation of the new and existing products that do not come under one of the Clinical Advisory Groups. These products are non CAG products.

The Panel consists of clinicians from a range of specialities and sub-specialities with expertise in the use of the types of prostheses on the list. The clinicians are nominated by the relevant learned colleges and craft groups from across Australia.

Each application to list a new "non CAG" product is assigned to two appropriate panel clinicians, in order to obtain balanced evaluations.

The terms of reference for the CAGs and PoCE are now included as appendices to Part 1 of the Prostheses List Guide.

Prostheses and Devices Negotiating Group

The PDC has appointed the members of the Prostheses and Devices Negotiating Group (PDNG), these members were nominated by the Australian Health Insurance Association. The PDC may also appoint nominees of the Australian Private Hospitals Association as benefit negotiators.

The PDNG negotiate appropriate benefits with the sponsors of products recommended by the PDC for listing on the Prostheses List. They also renegotiate benefits for listed prostheses annually.

The operating procedures for the PDNG are now included as an appendix to Part 1 of the Prostheses List Guide.

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