Evaluation of the National External Breast Prostheses Reimbursement Program

4.2 Participation in the program

Page last updated: 05 November 2010

Of the 362 survey respondents, around two thirds (67%; 214 women) had taken part in the program.

The remaining third of survey respondents, who did not claim under the program, provided a number of reasons for not doing so. However, the primary reason given (by almost half of non-claimers), was that they did not require a prosthesis during this period. About one quarter of non-claimers said that difficulty lodging an application form for the program prevented them making a claim. A range of other reasons applied to smaller proportions of respondents. These results are shown in figure 9.

Figure 9 – What was the reason/s that you did not make a claim for reimbursement through the program (n=105; multiple response)

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Text version of figure 9

Reason for not claiming

Number

Claimed through program214
I did not need a breast prosthesis during this period51
I had difficulty lodging an application form for the program27
I did not wish to pay up front for the breast prosthesis, which is required before claiming under the National External Breast Prostheses Reimbursement Program10
I had not heard about the National External Breast Prostheses Reimbursement Program8
I claimed expenses for breast prostheses through private health insurance7
I was not able to pay to purchase the breast prosthesis, which is required before claiming under the National External Breast Prostheses Reimbursement Program6
I had heard of the National External Breast Prostheses Reimbursement Program, but did not know how to make a claim through this program6
I made a claim through a state/territory aids and appliance or external breast prostheses program5
I did not have useful information about the program5
I claimed expenses for breast prostheses through the Department of Veterans' Affairs1
I had difficulty accessing an application form for the program1
I had difficulty completing an application form for the program16
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4.2.1 Characteristics affecting women's use of the program

As noted, survey respondents are not statistically representative of all women who have accessed the program due to the limitations in reaching all women who had claimed through the program. However, as creating a profile of the respondents who had not accessed the program could potentially indicate some barriers to access, cross tabulations and chi square tests were performed on a selection of characteristics, including age, state and remoteness of residence, previous use of state and territory prosthesis programs, involvement with one or more support groups, recency and type of mastectomy.

Only two factors proved to be statistically significant:
  • Respondents whose mastectomy had been in the last 24 months were significantly more likely to have made a claim through the program (83%) than those who had had a mastectomy 2 to 5 years ago (54%) or more than 5 years ago (58%).
  • Interestingly, those who had previously accessed a state or territory based prosthesis program were significantly less likely to have made a claim through the national program (56%) than others (72%).
Some stakeholders interviewed suggested remoteness of residence was a barrier for women accessing the program, particularly because those in rural areas or small towns may not have access to the wider range of health services and networks available in urban areas.

Some stakeholders also expressed concern that older women were not accessing the program due to the fact that:
  • they may have had their mastectomy some time ago and are no longer regularly seeing a health care provider in relation to their experience of breast cancer
  • they may not know that external prostheses are available or that there is a reimbursement program to assist
  • they may not be involved with breast cancer organisations, support groups or communication channels which have publicised the program
  • they may live in rural areas and not have ready access to mainstream services or access to a prosthesis fitter.
Some stakeholders considered that knowledge about the program was influenced by women's involvement with breast cancer-related groups and networks, due to the fact that this is where information has primarily been disseminated about the program, and where women are likely to find out about the program from other women who have used it. However, the primary means of access to information (as identified in interviews and in figure 8) does appear to be breast care nurses and prosthesis fitters and suppliers. It may be that women first hear about the program from their breast care nurse or prosthesis fitter, and are able to find out further information, or receive encouragement to access the program, from their own breast cancer network or support group.

It is important to treat participation in the program as distinct from access to the program (which may be affected by factors such as those listed above, as well as awareness and understanding of the program). As shown in the previous section, the program may be unused by women until they require a replacement prosthesis. It is also significant that not all women who have had a mastectomy may need or want to use the program, particularly if they undergo reconstruction surgery soon after their mastectomy. It may be that many women are aware of the program but have not chosen to access it yet, although they may do so in the next year or two as their current prosthesis wears out or they complete current treatment regimes.