Catholic Health Australia has doubled-down on concerns that under-pressure regional Victorian hospitals will be impacted when the federal government's funding model changes for hundreds of surgical items.
The Prostheses List is used by the federal government to determine how much private health insurers must pay for products listed.
Under reforms announced in 2021, about 400 items will be removed from the list in July next year.
They include staples and adhesives used to close wounds.
As part of a new bundling model, items no longer on the Prostheses List will be grouped together and funded per procedure, instead of individually.
The Independent Health and Aged Care Pricing Authority is due to advise the sector and federal government on revised prices in mid-December.
Catholic Health Australia, which is one of the country’s biggest private hospital providers, said a new funding source to support the bundling model was yet to be found, months after the organisation first raised its concerns.
The organisation's health policy director, Caitlin O'Dea, said the changes would cause a $100 million annual funding hole at its network of 75 hospitals, a quarter of which were regional.
Ms O'Dea said patients would at worst be left out-of-pocket.
She said some hospitals couldn't absorb the cost and surgeries would be impacted.
"When we look at the data, regional hospitals are particularly impacted, and surgeries on women are particularly impacted … caesareans, cancer surgery," she said.
"I don't think it's exaggerating to say it would be diabolical."
But Private Healthcare Australia chief executive Rachel David said Catholic Health Australia's concerns were unfounded.
"We want to re-assure people all the items will be funded," Dr David said.
"We're just changing the way they'll be paid for."
Members Health Fund Alliance chief executive Matthew Koce said any statements made by Catholic Health Australia on the subject were highly speculative.
He said it would be irresponsible for anyone to pre-empt the Independent Health and Aged Care Pricing Authority's advice.
Push for trial
Catholic Health Australia has written to the federal government to ask if a two-year shadow pricing trial of the new system could be conducted by the authority.
"That trial period would make sure we could accurately say the expected vs actual outcomes of this change are considered," Ms O'Dea said.
But Dr David and Mr Koce said the trial was unnecessary.
In a statement, a spokesperson for Health Minister Mark Butler didn't directly address the call for a trial.
"The Department of Health and Aged Care continues to engage with stakeholders about a number of independent reviews in the private health sector," the spokesperson said.
"These reviews aim to ensure that Australians have access to high quality and affordable treatments and devices."
