The following is a response from the Southern Cross Health Society to a Q&A article with Ophthalmology New Zealand (ONZ) about its work with the country’s health insurance providers and Southern Cross’ delay in funding products, such as Xen for glaucoma patients.
I am writing in response to an article titled, ‘ONZ tackles health insurers’ in the March 2019 issue of NZ Optics.
The article claimed that Southern Cross Health Society (SCHS) requires Level 1 evidence for new technology in relation to XEN. This is incorrect. Like the profession, we desire high quality evidence of benefit to our members (accepting down to Level 3 or lower in a contextual approach) as well as a cost benefit using QALY measurements.
XEN implants were reviewed late last year and accepted for funding by Southern Cross according to the pricing advised by the original ophthalmology applicant in the private sector. Unfortunately, we have been unable to contract with any provider at this pricing level following its approval, with all suggested pricing significantly higher than that originally proposed, demonstrating inadequate QALY benefit compared to existing technologies.
The article also claimed that SCHS does not allow its members to pay additional amounts to access new technologies. This is misleading. SCHS is a Friendly Society which exists for the benefit of its members and “gap” payments, other than for pre-agreed excesses, shared cover contributions under their policy or policy exclusions, undermine the concept of health insurance in this context. We know in Australia, where for-profit insurers and providers have together long embraced this concept, ultimately patients have become worse off and the problem has not been solved.
We understand rising costs are an issue for all of us operating in the health sector and ultimately will determine whether patients can continue to sustain private healthcare long term. We want to work together to find better value and delivery models of care that patients rightly expect. We are eager to ensure mutual respect through constructive dialogue and honest interactions, whether with ONZ on matters affecting the sector, like new technology and expertise, or when discussing individual funding arrangements with ophthalmologists.
As an example, the field of MIGS is rapidly growing, and for this reason we have recently drafted a broader paper looking at the total “pathway” of care to allow clinicians to use best evidence, best value care for our members where appropriate. We welcome working in discussion with ONZ and the glaucoma subcommittee on this matter, continuing some of our recent conversations regarding eligibility criteria for corneal cross linking.
Stephen Child, chief medical officer, Southern Cross Health Society
See original article at www.eyeonoptics.co.nz/articles/archive/onz-tackles-health-insurers/