Evaluation of the National External Breast Prostheses Reimbursement Program

Executive summary

Page last updated: 05 November 2010

In June 2009, the Department of Health and Ageing (the department) commissioned Urbis to undertake an evaluation of the National External Breast Prostheses Reimbursement Program.

This evaluation involved two parts – a review of the administration of the program; and a review of the impact of the program on the lives of women who have had a mastectomy as a result of breast cancer.

The administration review evaluated the appropriateness, effectiveness and efficiency of the program’s administration in reference to the business rules and the principles for the administration of the program for the first twelve months of its operation (December 2008 to December 2009). This review also explored opportunities for future improvements or directions to the program's administration.

The impact review evaluated the impact of the program in meeting its objectives which include, but are not limited to, improving the quality of life of women who have undergone a mastectomy as a result of breast cancer. The impact review also heard from women regarding issues of concern and suggestions which may strengthen the program's effectiveness and maximise its potential for success.

The evaluation was conducted by Urbis over an eleven month period and included documentation review, consultations with 44 individuals from 27 stakeholder organisations either face to face or through telephone interviews; and consultations with 377 women through a survey, telephone interviews, emails and focus group.

Key findings

Administration of the program

Overall, the program demonstrated a number of achievements in its first year.
  • In total 17,997 claims had been processed and 19,962 reimbursements paid by 31 December 2009; the total cost of the reimbursement program to the Commonwealth amounted to $6,130,011.52.
  • The reimbursement scheme was considered to be nationally consistent, easily accessible; efficient in process; and sensitive to the needs of women accessing the program.
  • Respondents considered that the program had contributed to the quality of life for women who had undergone a mastectomy as a result of breast cancer and required a breast prosthesis.
  • The business rules and service arrangement between the department and Medicare Australia provided an acceptable and appropriate structure for the program. Top of page

Impact of the program

Consultations with representatives of stakeholder organisations and women who had accessed the program indicated primarily positive perceptions of the program.
  • Over three quarters of women responding to the survey (77%) agreed or strongly agreed that the program had improved their quality of life.
  • More than three quarters (81%) of women surveyed agreed or strongly agreed that they were treated with sensitivity whilst making their claim.
  • Over three quarters (76%) said that they had been pleased with their overall experience of the program.
  • Breast care nurses and breast prostheses suppliers were the leading sources of information about the program. Forty-two percent of women surveyed reported hearing about the program from their breast care nurses, and over one third (34%) reported hearing about the program through a breast prostheses supplier.
  • The large majority of women consulted (83%) reported that the program had made it easier to afford a breast prosthesis.
  • The program was praised for its simplified claims process. More than three quarters of women surveyed (79%) said that they had found the process of being reimbursed was straightforward.
  • Overall, respondents reported that the program was a significant improvement on previous state and territory-based schemes.
Several areas of improvement or concern were identified.
  • A number of respondents commented that the program required wider promotion.
  • Only half (50%) of women surveyed agreed that a reimbursement every two years is sufficient.
  • The inability to afford the upfront payment for an external prosthesis, particularly for women experiencing financial hardship, was a concern of many respondents, although the extent of this is not quantified.
The following proposals are made for the future.
  • The program is promoted in a more targeted way to clinicians and consumers, through the media, at BreastScreen units, and through targeted advertising.
  • Consideration is given as the program progresses to research which will quantify the number of women who may be prevented from accessing the program because they are not able to afford the initial purchase of a prosthesis.
  • Consideration is given to providing discretion for reimbursements within the two-year time frame within a carefully described set of circumstances, particularly weight loss due to cancer treatment.
  • Information and promotional resources are developed in languages other than English, and promoted to a wide range of culturally diverse community groups.