Evaluation of the National External Breast Prostheses Reimbursement Program

3.4 Improvements in the administration of the program and duplication

Page last updated: 05 November 2010

3.4.1 Improvements to processes and administration of the program
3.4.2 Duplication

3.4.1 Improvements to processes and administration of the program

The following suggestions were made by respondents with regards to possible improvements to the administration of the program.

Communication and promotion of the program

The large majority of respondents agreed that the most effective means of finding out about the program was either through a breast care nurse or a breast prosthesis fitter. However it was believed that more could, and should, be done to promote the program more widely for those who may not have access to these specialists. For instance one woman who lived in a regional area said that it had taken some time for her to find out about the program because there were no prosthesis fitters in the area.

Many commented that lack of promotion was a significant weakness of an otherwise sound program - "it's a fantastic program [however] all the benefits are outweighed by the lack of information out there for women [about the program]". Whilst some respondents acknowledged that they had received initial communication about the program from Medicare Australia and a few women had seen promotional material displayed in Medicare Australia offices (as per Medicare Australia's communication plan detailed in section 3.2.2), it was felt that "the program has very much relied upon the initial press flurry when the program was first announced [and] this has since died off". There was concern that "for people going through the pathway now, you can only hope their breast care nurse or prosthesis fitter is telling them about the program".

Whilst information provided on the Medicare Australia website is useful, it was thought that this shouldn't be relied upon as a primary form of communication. The fact that all communication about the program is in English was also seen as a barrier to those from a cultural and linguistically diverse background, or to Aboriginal and Torres Strait Islander women accessing the program. A number of respondents stated that there needed to be written information about the program provided in languages other than English. Medicare Australia reported that a review of this is due to take place later this year.

The promotional flyer/stand in Medicare Australia offices throughout October 2009 was praised as a good idea and it was suggested that this should be in place permanently. Top of page

It was also argued that women didn't necessarily realise that they had the option available to post claims.

Areas where respondents felt information could be promoted about the program included:
  • brochures at prosthesis suppliers, hospitals and Medicare Australia offices
  • radio and television commercials
  • through general practitioners and practice nurses during consultations
  • BreastScreen units
  • advertising at breast cancer events, such as the Mother's Day Classic Marathon in May.
Concerns were also voiced regarding communication on the reimbursement amount. One woman thought she would be reimbursed for a total fee of $400 and so purchased a soft inexpensive prosthesis post surgery for $66 and claimed on this, not knowing that this was all she could receive as reimbursement for the next two years. Other women have also been confused about the $400 amount and have purchased special bras for their prostheses thinking that because they had spent less than $400 for their prosthesis, they could include the cost of a bra to bring them up to the full amount.

Some women reported feeling uncomfortable or self conscious about going into a Medicare Australia office to claim. Many fitters and breast care nurses said that they had taken forms into Medicare Australia for women because of this. It was acknowledged however, that some women may be deterred from sending the claim form by post due to the additional time it would take for Medicare Australia to receive their claim. Very few women in fact reported that they had submitted their claim by post. Top of page

Availability of claim forms

It was felt that more could be done to improve the availability of claim forms for women, in particular for those who were not familiar with using the internet or who were some distance from a Medicare Australia office. It was suggested that hard copy claim forms be distributed to fitters and breast care nurses to make them more available to women, as these two avenues are generally where women first find out about the program.

Cash payments and bulk billing

It has been reported that there is a perception that the program forms part of the Medicare Benefits Schedule, and this has led to queries from some women regarding the ability to receive over the counter reimbursements under the program.

It was suggested by some respondents that the program be administered through a cash payment or bulk billing system. It was thought that fitters could register with Medicare Australia and use a HICAPS terminal when charging women for their prosthesis, so that their payment would be bulk billed up front. This would place a large degree of risk on fitters, however, and would potentially incur an enormous cost to establish in terms of IT software required.

While currently the program operates as a reimbursement program, this may need to be monitored over the next few years of the program to assess whether there would be benefits in changing the mode of reimbursement.

Including the cost of prostheses-specific bras in the $400 reimbursement

It was also suggested that women be able to include the cost of prostheses-specific bras in the $400 reimbursement amount, as these bras are more expensive than the average bra. For instance if a woman spent $320 on a prosthesis, she could also claim $80 on a bra to bring the full amount up to $400.

As reported by one breast care nurse, "some women will go without a fitted prosthesis if they cannot afford the bra, as they consider the prosthesis useless without the bra".

It was noted that Department of Veterans Affairs reimbursement scheme included reimbursement for a breast prosthesis and two bras. Top of page

3.4.2 Duplication

There were no reports where duplication was an issue for the administration of the program.