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The Community Affairs Legislation Committee recently (Feb 05) discussed amendments to the Provisions of the National Health Amendments (Prostheses) Bill 2004.
Issues and recommendations related to implantable prostheses etc and podiatric surgeons in Australia were made, further assisting the degree by which private health insurers are enabled to pay for this component of podiatric surgery.
The Senate document is located by following this link:Senate Report
Last edited by LuckyLisfranc : 13th February 2005 at 06:48 PM.
Reason: spelling error
I watched Mark Gilheany and John Price on webcam testify before the Senate committee reporting on this - they did real good; made a good case and the committee was most interested in the podiatric / orthopaedic surgeon difference. (Political junkie and parliament watcher, Hylton Menz alterted us to this web cast)
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Thanks to Hylton, here is the relevant text from the docment that Anthony linked above:
Quote:
Podiatric surgeons and prostheses
1.32 Podiatric surgeons provide a specific professional service. They perform minor and mostly relatively straightforward surgical procedures on the feet and toes. Podiatric surgeons generally are qualified podiatrists, but they are licensed to provide their specialist and highly-skilled services on the basis of extensive relevant further experience and postgraduate training.
1.33 As podiatric surgeons are not qualified medical practitioners, services provided by them are not eligible for Medicare benefits. In 2004, however, the Government amended the National Health Act to allow podiatric surgeons to receive private health insurance benefits notwithstanding their lack of Medicare eligibility.
1.34 In his second reading speech, the Minister for Health and Ageing stated: There have been recent changes to health insurance legislation that enable members to access basic hospital accommodation and nursing care costs for services performed by accredited podiatric surgeons. In those circumstances, I encourage health funds to cover the prostheses implanted by podiatric surgeons.34The Committee agrees with the Minister's view, as it is desirable both to extend the range of choices available to fund members, as well as to offer funds at a lower cost option per podiatric surgical service.
1.35 In its evidence to the Committee, however, the Australasian College of Podiatric Surgeons (ACPS) argued that the Minister’s statement in itself may not be enough to achieve this goal. It also commented that certainty is needed through this Bill to ensure that not only the hospital episodes provided by podiatric surgeons are eligible for private health insurance benefits, but prostheses provided by podiatric surgeons are similarly covered.
1.36 In its submission, the College stated that: Private insurance companies have indicated that they will not pay for these [prostheses] unless podiatric surgeons are specifically allowed for in the legislation…The ACPS applauds the intent of the Government in this matter but is none the less concerned that without specific legislative amendment to the Act the insurance industry will not comply with the intent of the Government.35The College also indicated that several private health insurance funds had made it clear that, notwithstanding the legislative recognition given last year, some funds had indicated that they had no intention of extending their cover to podiatric surgeons' services.36
1.37 The Committee has great sympathy with this view. While not suggesting that funds should be forced to offer podiatric cover, it is important that fund members either have the option of obtaining podiatric surgical services through their private health policy, or have the option of switching to another policy – or another health fund. The Committee does hope, however, that individual funds are basing their decisions about whether or not to cover podiatric services on sound clinical and cost grounds. It would be concerned if some funds were deciding not to offer podiatric surgical cover without careful consideration of the relative costs and benefits to their members.
1.38 By making it clear in the legislation that prostheses inserted in podiatric surgical procedures are coverable, the Government's commendable extension of benefit coverage to related hospital benefits would also be applied to prostheses provided in those procedures.
1.39 The Committee therefore recommends that the Government make appropriate amendments to the Bill to make clear that funds can cover the cost of the prostheses provided in podiatric surgical procedures.
1.40 It also recommends that the Private Health Insurance Ombudsman, as an independent guardian of consumer interests, monitor private health funds' consideration and coverage of podiatric surgical services. It would also be desirable for the Ombudsman to comment on progress in his regular public reports.
1.41 The Committee noted that the College's submission did not make a case for extending private health benefits to podiatric surgeons’ services themselves. However, their ambiguous situation highlights that increasingly the regulation of private health cover, including the linking of benefit eligibility to professional services also covered by Medicare, is out of kilter with the reality of providing professional health services.
1.42 The Committee considers that it is desirable that future reviews of private health cover should consider seriously the future treatment of podiatric surgery services, whether or not they are also covered by the Medicare Benefits Schedule.
Recommendation 1 1.43 The Committee reports to the Senate that it has considered the National Health Amendment (Prostheses) Bill 2004 and recommends that the Bill be passed with appropriate amendments to ensure that there is no impediment to prostheses implanted by a podiatric surgeon attracting a private health insurance benefit.
Recommendation 2 1.44 The Committee recommends that the Private Health Insurance Ombudsman monitor the implementation of the new podiatric surgical cover provisions and report on progress in the Ombudsman's annual State of the Health Funds report.
Recommendation 3 1.45 The Committee recommends that future reviews of private health insurance cover should consider whether benefits should be paid for the professional services of podiatric surgeons, whether or not those services are also eligible for a Medicare benefit.
Podiatric Surgeons recommended in National Health Amendments (Prostheses) Bill
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