Terms of Reference - Industry Working Group on Private Health Insurance Prostheses Reform

Page last updated: 17 February 2016

  • The role of the Industry Working Group on Private Health Insurance Prostheses Reform is to examine opportunities for reform of the arrangements governing prostheses and devices access and pricing in the private health insurance sector to ensure;
    • Better access to prostheses and devices for consumers as part of the private health care offering;
    • Reduced red tape and administrative burden for private health insurers;
    • Opportunities for competition across the supply chain are maximised for the benefit of consumers and taxpayers.
  • In conjunction with the Department, the Group will assess the current system, including the Prostheses List Advisory Committee and Clinical Advisory Group processes.
  • The Group will advise the Department on a preferred reform option with a particular focus on:
    • Creating a more competitive basis for the purchase and reimbursement of prostheses and devices, including consideration of options for implementing new pricing arrangements such as price referencing and price disclosure models;
    • Identifying specific products or categories of products which may present opportunities for immediate benefit rationalisation;
    • Refining the scope of products currently on the Prostheses List without adversely impacting on appropriate access for consumers; and
    • Other opportunities for deregulation.


  • Members of the Industry Working Group on Private Health Insurance Prostheses Reform are appointed for their knowledge and expertise. Members will be required to sign confidentiality agreements and declare any real or potential conflicts of interests at the commencement of each meeting.


  • The recommendations of the Group will be considered by Government as part of a private health insurance reform package, with a view to commence implementation as part of the August 2016 Prostheses List.
  • The Group will meet in person or via teleconference on a limited number of occasions, in order to provide advice to the Department as soon as possible.