Evaluation of the National External Breast Prostheses Reimbursement Program

4.3.4 Outcomes of participation in the program

Page last updated: 05 November 2010

The reimbursement itself
Inclusions in the reimbursement
Impact on affordability of a breast prosthesis
Effect of the required up front payment on accessibility of the program
Overall satisfaction with the program and its impacts

The reimbursement itself

Figures 17 and 18 below relate to the level and frequency of reimbursement available under the program. Figure 17 shows that 88% of respondents gave a favourable rating (3 to 5) for the reimbursement amount. Similarly, figure 18 shows that 75% of respondents agreed that the amount was sufficient.

The level of reimbursement was viewed less favourably by older respondents and those who had previously accessed another program.
  • Respondents aged 70 and over were less likely to agree that 'The level of the reimbursement for an external breast prosthesis under the program was sufficient' (60%) than those aged 50 to 69 years (80%) and those up to 49 years (71%).
  • Respondents who had previously accessed a state/ territory based prosthesis scheme were more likely to disagree that 'The level of the reimbursement for an external breast prosthesis under the program was sufficient' (13%) than others (8%)
In contrast to views on the amount reimbursed, attitudes to the frequency of reimbursement were somewhat ambivalent. Only half the respondents (50%) agreed that the reimbursements under the program were sufficiently frequent, and almost one third (30%) disagreed.

Among survey respondents, younger respondents and those who had previously used other programs were least satisfied with this aspect of the program.
  • Respondents aged up to 49 years were less likely (37%) to agree that 'the frequency of reimbursement for an external breast prosthesis under the program (i.e. every 2 years) is sufficient' than those aged 50 to 69 years (54%) and those aged 70 years or over (57%).
  • Those who had accessed state/ territory based prosthesis programs were less likely (47%) than others (53%) to agree that 'the frequency of reimbursement for an external breast prosthesis under the program is sufficient'. Top of page
Lower satisfaction with the frequency of reimbursement was echoed in verbatim responses and interviews. Some women felt that there were unavoidable circumstances where women would need replacement prostheses before the elapse of the required two year period. This was particularly the case with women who, due to hormone treatment and chemotherapy, lost or gained large amounts of weight within a period of months. In most cases these women were then unable to wear their prostheses which were moulded to their former body shape.

Whilst it is understood that most prostheses have a manufacturers guarantee for up to two years, type of prostheses and climate were also noted to affect their longevity, as was level of physical activity; the latter may explain why younger respondents who may be more physically active, were less satisfied with this aspect of the program, and this link was also suggested in interviews with consumers.

The following comments were made with reference to the frequency of reimbursement:

"I purchased a prosthesis last year following my second mastectomy that is now four times too big for me. Due to the type of chemotherapy I've been receiving I have gone from 65kg to 47 kg. I can't wear the prosthesis as it is much too big for me – unless I pump up the other breast [prosthesis], but this one is very old and falling apart and I can't afford to replace it."

"Because of the treatment that I am on (Tamoxifen), I have found that my right breast is getting less full and that my prosthesis is too large."

"At the time I had lost a lot of weight and so got a prosthesis that was suitable for my size. Within six months I have put on weight and think I will have to get a bigger size of prosthesis soon, but realise I will not be reimbursed for it."

"Two years is fine for people with stage one breast cancer. I have had stage four breast cancer for the last eight years. With weight gain and loss due to treatment I have had to purchase two prostheses myself [without reimbursement]."

"I think it would be much better for the government to provide the reimbursement yearly – I wear a 'contact' prosthesis [which is stuck onto the chest] and these only last just over a year."

"Because I live in a tropical climate, every twelve months would be more appropriate for me, as the prostheses do not last long in this environment." Top of page

Figure 17 – On a scale of 1 to 5, where 5 is the best score, how would you rate the following aspects of the program? (n=214)

Text version of figure 17

Rating
Percentage
Not sureSmall percentage
17
24
312
415
560
Top of page

Figure 18 – On a scale of 1 to 5 where 1 is 'strongly disagree' and 5 is 'strongly agree' please indicate how much you agree or disagree with the following statements about the program (n=214)

Text version of figure 18

The frequency of reimbursement for an external breast prosthesis under the program (i.e. every 2 years) is sufficient
Agreement
Percentage
Not sureSmall percentage
Strongly disagree14
Disagree15
Neutral17
Agree16
Strongly agree34
The level of the reimbursement for an external breast prosthesis under the program was sufficient
Agreement
Percentage
Not sureSmall percentage
Strongly disagree6
Disagree5
Neutral13
Agree17
Strongly agree58
Top of page

Inclusions in the reimbursement

A number of women felt that the cost of prostheses-specific bras should be included in the $400 reimbursement amount (as discussed in section 3.4.1). Many reported that the cost of these bras was far more than for ordinary bras. It was also reported by women that swimming and aqua exercise was often recommended for recovery, but that they then had to purchase a second 'swimming' prosthesis. Some suggested that the swimming prosthesis could be covered under the program too.

Women commented that:

"The program would be improved if the reimbursement could include at least part of the cost for the bra to wear with the prosthesis. The price of a mastectomy bra is high and you need at least two garments to manage."

"Reimbursement for a bra would be helpful because they cost more than ordinary bras."

"For women who may require a second (swimming) prosthesis this could be quite an expensive outlay."

Impact on affordability of a breast prosthesis

Figure 19 indicates a strong level of agreement that the program enhanced the affordability of breast prostheses. Over 80% agreed that this was the case, with over 70% agreeing strongly.

A slightly lower level of agreement was found among those who had previously accessed a state/ territory based program. This group were more likely to disagree with the statement (14%) than others (7%)

Figure 19 – On a scale of 1 to 5 where 1 is 'strongly disagree' and 5 is 'strongly agree' please indicate how much you agree or disagree with the following statement about the National External Breast Prostheses Reimbursement Program

Text version of figure 19

Agreement
Percentage
Not sure0
Strongly disagree6
Disagree3
Neutral8
Agree10
Strongly agree73
Top of page

Effect of the required up front payment on accessibility of the program

However, as noted in previous sections of this report, the up-front payment for breast prostheses prior to reimbursement is apparently considered difficult to afford by a number of people.

Some women reported in verbatim survey responses and interviews that whilst the program was of tremendous assistance to them, the initial up-front fee for the reimbursement was difficult to afford, particularly for older non-working women, and those having to pay for various aspects of their treatment. As discussed in section 3.4.1, many reported that they would have preferred not to have had to pay for their prosthesis up-front, and suggested that breast prosthesis fitters or suppliers bulk bill the prosthesis in order to address the up-front cost and "cut out the waiting period."

One interview participant anticipated that while she was recuperating from treatment and unable to work, it would be some months before she could afford a prosthesis. Such instances were not isolated, according to breast care nurses. Several breast care nurses also mentioned cases where women had sought donations from support groups to fund the upfront payment.

Although the available data does not allow the extent of this issue to be quantified, the finding that a substantial minority of survey respondents found the payment difficult to afford, combined with consistent feedback from interviews, suggest that equitable access to prostheses may be compromised under the current arrangement.

The following comments made by survey respondents all relate directly to this aspect of the program.

"What happens when someone is on a limited income (e.g. pension, unemployment, or very low income) and cannot afford the initial outlay?"

"The program is a huge help but would find a cash rebate at time of claim a great benefit." Top of page

"The big issue is coming up with the $400 up-front. I had to put it on my credit card then waited three weeks for reimbursement. After one week I enquired and was told there was a backlog."

"Some women will find it very hard to pay up-front for their prosthesis. Maybe some sort of voucher system would financially be much easier those who cannot afford the initial outlay."

"There is a need to look at the upfront payment as a lot of families have gone through tough times and some have reduced incomes."

"It was difficult to afford the prosthesis before and now due to circumstances, it would be virtualy impossible to pay upfront."

"I know of women that have not been able to afford the money to pay up front for their prostheses, especially if they have had a bilateral mastectomy and are on a pension."

"It was quite a hardship for me to find the money, being on a disability pension."

"So many people could not afford to have $400 taken out of their cash flow for three weeks. What about the cost to those with a double mastectomy? I know that in poorer years of my life I would have had to make do with a badly sized, damaged prosthesis."

"I haven't yet made a claim as I can't afford the up-front payment under the program. I am unable to save up as I am struggling to pay living expenses."

"I would really have liked to have just had to visit the Medicare office, fill in the claim form and receive the payment straightaway. It would have made paying for the prosthesis much easier… All other payments are upfront at Medicare with no questions asked." Top of page

Overall satisfaction with the program and its impacts

Figure 20 and 21 below relate to respondent's views of the program overall. They indicate that overall attitudes to the program are positive. Over 90% of respondents gave the overall experience of the program a favourable rating (figure 21). In addition, 77% of respondents agreed that the program had had a positive impact on their overall quality of life (figure 20).

Some variations were found between groups of respondents.
  • Respondents who had previously accessed state/ territory based prosthesis programs rated the overall experience of the national program less favourably (85%) than others (93%).
  • Respondents aged 70 years and over rated the overall experience of the program less favourably than those aged 50 to 69 years (96%) and those aged up to 49 years (87%). They were also less likely to agree that 'the program had a positive impact on my quality of life' (68%) than those aged 50 to 69 years (78%) and those aged up to 49 years (74%).
The overwhelming response given by women who provided comments to the evaluation was gratitude. Women were appreciative that their needs had been recognised, and that they were able to access a reimbursement that was nationally consistent and straightforward in process. Almost all commented on how the program had impacted on their quality of life.

Below are some of the unprompted comments that were received by survey participants which highlight their satisfaction with the program.

"This is a wonderful program… the recognition that it's not just a cosmetic issue but is a medical issue was a real boost to my recovery – it reinforced for me that self image is so important to moving forward after breast (or any) cancer." Top of page

"This is a valued program for breast cancer survivors – the external prosthesis is a must (if one doesn't have implants) and really helps to make one feel so much better about oneself."

"The program sent me into raptures – no more socks in my bra, no shoulder pads rising up outside my dress… thank you."

"Thanks for this program. I would not have been able to replace my breast prosthesis without this program."

"Thank heavens it's available! I would have found it very hard to afford without the government reimbursement being readily available!"

"Overall I was satisfied with the program and very grateful."

"Long time coming and just fantastic."

"I was very happy when I found out about the program as my prosthesis had split and I had to tape it up which was uncomfortable at times."

"I think the program is just the best thing for women after going through a mastectomy and knowing there is no hassle getting a new prosthesis every two years is very welcoming. Congratulations on a great program."

"I think that this program is a wonderful way of making affordable the replacement of a missing breast for women who have had a mastectomy as the outward and visible adaptive prosthesis enhances ones' self-esteem and self confidence. I am so grateful that this program exists."

"I think it is a great idea and was very pleased with all aspects of obtaining a reimbursement. It certainly made it easier for me financially as I might have resorted to a 'birdseed bag'! Thanks, keep up the good work." Top of page

Figure 20 – On a scale of 1 to 5 where 1 is 'strongly disagree' and 5 is 'strongly agree' please indicate how much you agree or disagree with the following statement

Text version of figure 20

Agreement
Percentage
Not sureSmall percentage
Strongly disagreeSmall percentage
DisagreeSmall percentage
Neutral16
Agree18
Strongly agree59
Top of page

Figure 21 – On a scale of 1 to 5, where 5 is the best score, how would you rate the following aspect of the program?

Text version of figure 21

Rating
Percentage
Not sureSmall percentage
1Small percentage
2Small percentage
315
431
545