Private Health Insurance - Prostheses List Reforms

Page last updated: 06 August 2018

In October 2017, the Government and the Medical Technology Association of Australia (MTAA), as advocates for Australia’s innovative medical technology sector, reached an agreement to:

  • promote the sustainability of privately insured health care through rebalancing the costs of medical devices to privately insured patients, to help keep private health insurance affordable for all Australians;
  • support a viable, innovative and diverse medical technology sector in Australia and local jobs; and
  • improve the value of private health insurance for consumers by reducing benefits for prostheses on the Prostheses List.

Agreement between the Government and the Medical Technology Association of Australia (MTAA)

Australian Government and MTAA Agreement 2017 – 2022: High Level Workplan

The Agreement Workplan will form the basis of the work the Government intends to undertake to:

1. Support sector stability and sustainability

2. Reduce the time to market for medical devices

3. Ensure Australian patients have access to safe, effective, and cost effective innovative medical devices in the private sector

4. Improve the transparency and efficiency of the Prostheses List arrangements

5. Recognise superior clinical performance

6. Support Australian medical technology innovation

PDF version: Agreement Workplan (PDF 86 KB)
Word version: Agreement Workplan (Word 40 KB)

Two year clinical evidence requirements

PDF version: Two year clinical evidence requirements (PDF 73 KB)
Word version: Two year clinical evidence requirements (Word 18 KB)

Prostheses List Reform Governance Group

The Governance Group will monitor the implementation of the Australian Government – MTAA Agreement and oversee the operation of the three Industry Working Groups. It will define performance data to inform the evaluation of the Agreement and consider the management of commercially sensitive information during this program of work. The Agreement will be reviewed by the Governance Group in 2021.

PDF version: Prostheses List Reform Governance Group Terms of Reference (PDF 226 KB)
Word version: Prostheses List Reform Governance Group Terms of Reference (Word 162 KB)

Industry Working Groups

As part of the agreement with the MTAA, the Government committed to establish three working groups:

  • Revised Benefit Setting and Review Framework Industry Working Group to develop a revised framework for benefit setting and benefit review.

PDF version: Revised Benefit Terms of Reference (PDF 164 KB)
Word version: Revised Benefit Terms of Reference (Word 517 KB)

  • Cardiac Technical Support Services Industry Working Group to determine how technical support services for active implantable cardiac devices should be funded.

PDF version: Cardiac Technical Terms of Reference (PDF 676 KB)
Word version: Cardiac Technical Terms of Reference (Word 518 KB)

  • Quality of Information and Guidance Industry Working Group to improve the quality of information provided to applicants in the Prostheses List – Guide to Listing and Benefits (the Guide) and the Prostheses List Management System (PLMS).

PDF version: Quality of Information Terms of Reference (PDF 720 KB)
Word version: Quality of Information Terms of Reference (Word 644 KB)

Further Information

Australian Government MTAA Agreement news and communiques

For further information please contact prosthesesreform@health.gov.au