Evaluation of the National External Breast Prostheses Reimbursement Program

3.2 Outcomes achieved as a result of Medicare Australia administering the program

Page last updated: 05 November 2010

Consultations suggest that Medicare Australia has been successful in its administration of the program. Many respondents said that they had been supportive of the department's decision to appoint Medicare Australia to the administration of the program. Overall, it was seen as appropriate that Medicare Australia administer the program due to the fact that:

  • women were familiar with Medicare Australia, and the organisation's processes
  • Medicare Australia has administered other programs of a sensitive nature and therefore had experience in ensuring a sensitive approach in its dealings with women
  • Medicare Australia has existing infrastructure on which this program could build and it has experience in managing large national programs
  • the process allows women to remain anonymous – previous programs required women to come into a hospital or Cancer Council offices (depending on the state or territory) to obtain a prosthesis
  • it is a less stressful process for women as it is just a "one stop shop" visit to a Medicare Australia office
  • Medicare Australia is best suited to administer a national program due the fact that it operates on a national scale and has offices in all metropolitan and regional areas
  • Medicare Australia is a government agency and is familiar with Commonwealth financial accountabilities and privacy requirements
  • the contractual arrangements with the department allow for an appropriate accountability structure to be put in place by Medicare Australia to monitor the measure nationally
  • by facilitating a nationalised program, Medicare Australia can collect standardised data for women who use a prosthesis, how much these women are paying for their prostheses, and the reimbursement women are receiving
  • Medicare Australia has the capacity and IT systems in place to process timely payments
  • Medicare Australia has a centralised claims assessment system, which allows for consistency in assessments and tailored training of Medicare Australia processing staff for the program.
3.2.1 Consistent and straightforward approach
3.2.2 Communication of the program to the sector and general public
3.2.3 Medicare Australia data on claims made to date
3.2.4 Timeliness of reimbursement payments
3.2.5 Responsiveness to the needs of women

3.2.1 Consistent and straightforward approach

One of the key outcomes achieved as a result of Medicare Australia administering the program has been that the reimbursement process is straightforward, efficient and requires little effort on the part of women. One stakeholder commented that administration of the program by Medicare Australia has proven that it is possible to have a streamlined process for reimbursement, and that this has made it more simple for women who have "so many things to deal with in their battle with cancer". Another commented that women see it as a "Medicare program, that it doesn't need to be glossed, that it's seen as professional".

Medicare Australia was also praised for its consistency in making payments to women. Whilst there were some concerns about the timeliness of women receiving payments, overall, stakeholders and women reported that they had been satisfied with the payment process and the fact that the reimbursement was paid directly into their account electronically. The claim form was also praised for its simplicity and objectivity. One woman commented that the "procedure was extremely swift and competent." Women found the claim form easy to obtain and to complete and were pleased that they did not have to provide other proof of surgery or personal details. Top of page

3.2.2 Communication of the program to the sector and general public

The following communication strategies were undertaken by Medicare Australia in consultation with the department, to communicate the program to the sector and the general public:
  • A4 claim form incorporating a fact sheet available in Medicare Australia offices and on the Medicare Australia website
  • information provided on the Medicare Australia website in In Focus and Let's talk about
  • display of posters, brochures and other promotional material in Medicare Australia offices
  • promotion of the program through LCD screens in Medicare Australia offices
  • through the monthly theme in Medicare Australia offices
  • placement of colour posters and placemats in all Medicare Australia offices during events and awareness periods (for instance during Breast Cancer Awareness month in October 2009)
  • website links to key breast cancer organisations
  • external promotion via: website link with BCNA, NBOCC; supply of claim form and information sheets to the McGrath Foundation; mail outs (electronic and post) to major hospitals providing breast cancer surgery or support services, including a supply of claim forms and information sheets
  • editorials in relevant departmental health service publications, such as 'Carer's News', 'Rural News' and 'News for Seniors'
  • media monitoring
  • media release regarding key messages (how many women have used the program), and distribution (targeted at women's publications and health publications)
  • internal communication about the program for Medicare Australia staff as needed
  • through use of eReference regarding information related to Q&A, claim forms and information sheets. Top of page

3.2.3 Medicare Australia data on claims made to date

The following presents a summary of Medicare Australia data for the program for the period of 24th November 2008 to the 31st of December 2009. The data includes the total number of reimbursements since the inception of the program, the total amount reimbursed, a demographic breakdown of those who had been reimbursed, and process performance.

By 31 December 2009, following a full year of operation:
  • some 17,997 claims had been processed and 19,962 reimbursements paid
  • the average purchase cost of a prosthesis was $373.65 and the average reimbursement per claim was $340.69
  • the total cost of the reimbursement program to the Commonwealth had amounted to $6,130,011.52; rebates through private health funds had totalled $353,221.35 and state and territory rebates had totalled $58,615.50. 'Other' rebates had totalled $26,434.06.
An age breakdown of the data shows that by the end of the first year of the program, just over three quarters (77.4%) of women who received reimbursements were aged between 50 and 80 years (as indicated in table 6 below). Close to one third (32.6%) of the women were aged between 60 and 70 years.

By 31 December 2009, the state with the greatest number of reimbursements was New South Wales (37.8%) as indicated in table 7 below.

The following points of comparison can be made from the data:
  • The number of total claims increased quite rapidly, from 11,899 in August 2009 to 17,997 in December 2009; however so did the number of claims that were rejected (an increase of 45%; from 70 in August to 153 in December).
  • The number of total reimbursements also increased from 13,208 in August 2009 to 19,962 in December 2009.
  • The average purchase cost of a prosthesis increased only marginally ($5.26) from $368.39 to $373.65 per prosthesis.
  • The total cost to the Commonwealth in providing reimbursements had almost doubled during the four months from August to December 2009, rising from $3,933,223.27 to $6,130,011.52.
  • Rebates through private health funds also increased from $273,729.51 in August 2009 to $353,221.35 in December 2009.
  • Rebates through state and territory governments stayed roughly the same ($57,335.50 in August and $58,615.50 in December); and there was only a marginal increase in 'other' rebates from $24,732.91 in August 2009 to $26,434.06 in December 2009.
Program activity was higher during the four months between August and December than in previous months, suggesting information about the program was successfully reaching women. There was an information campaign in October 2009 for Breast Cancer Awareness Month (organised by the Breast Cancer Foundation), with flyers posted in all Medicare Australia offices and through other organisations. This may have assisted in raising awareness of the program.

Whilst it is not possible to estimate what proportion of women who use prostheses nationwide are accessing the program (as it is not known how many women choose to use prostheses), on the whole it appears that Medicare Australia has been successful in its administration of the program to date. The data above is reflective of the overall feedback received from respondents for this evaluation.

Some respondents suggested that some of the Medicare Australia program data be made public to organisations such as the Cancer Council and advocacy groups, as it would be useful for them to gauge how many women were using the program. Top of page

Table 6 – Age breakdown of women who had been reimbursed (November 2008 to December 2009)

Age range

% of those reimbursed (n=19,962)

Under 20 years0.0
20-30 years0.3
30-40 years2.1
40-50 years10.4
50-60 years21.6
60-70 years32.6
70-80 years23.3
80-90 years8.8
90 years and over0.9

Table 7 – Reimbursements by state or territory (November 2008 to December 2009)

State/territory

% of total reimbursements provided (n=19,962)

NSW37.8
Qld20.0
Vic17.1
WA10.8
SA8.8
Tas2.7
ACT2.3
NT0.5
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3.2.4 Timeliness of reimbursement payments

As discussed in section 3.1.2, Medicare Australia data shows that by December 2009, 99.78% had received their reimbursement payment within the stated ten business days. This is well within the performance indicators specified in the business rules for administration of the program.

Generally women consulted were satisfied with the period of time taken to receive their reimbursement. A small number of women reported that they had had to wait up to six weeks to receive their payment.

3.2.5 Responsiveness to the needs of women

Overall, women felt that they were treated with sensitivity and compassion by Medicare Australia when submitting their claim for a reimbursement, and reported that their enquiries were handled well by Medicare Australia. Some 81% of women who completed the survey said that they were treated with sensitivity while making their claim. It was also felt by the department that "enquiry management arrangements [were] well established and managed properly" by Medicare Australia.

One woman noted that there was a delay in claim forms being available at her local Medicare Australia office, but that she had no problems once she had obtained a form.