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Make breast prostheses available for those in need.



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J O I N T M E D I A R E L E A S E

Stephen Smith MP

Shadow Minister for Health and Ageing Carmen Lawrence MP Shadow Minister for the Status of Women

89/2002 Wednesday 23 October 2002

MAKE BREAST PROSTHESES AVAILABLE FOR THOSE IN NEED

The Shadow Minister for Health, Stephen Smith and the Shadow Minister for the Status of Women, Carmen Lawrence, today called on the Federal Government to ensure that breast prostheses are provided free of charge in public hospitals to women throughout Australia who undergo mastectomies.

“The current arrangements for the supply of breast prostheses are inequitable and unfair,” said Mr Smith.

“The arrangements differ in each State and Territory and even within each State, often at the discretion of each hospital.

“Some hospitals require patients to make a co-payment towards the cost of their first prothesis or only make external prostheses available for patients with a health care or other concession card.

“The availability of a prostheses shouldn’t depend on a woman’s postcode,” said Mr Smith.

“If breast prostheses were readily available, women will never again need to use degrading stop-gap measures such as filling bras with bird seed,” Dr Lawrence said.

“Breast prostheses are important to help women to adjust psychologically to the loss of a breast or breasts and also aid in reducing the physical problems related to poor balance which may cause further pain.

“The expense of external prostheses is particularly unfair to women in regional areas who are less able to access reconstructive surgery or radiotherapy and accordingly more likely to choose a full mastectomy procedure.”

Labor’s proposal would see funding for external breast prostheses made available through the Australian Health Care Agreements.

The current Agreements require that artificial limbs and surgically implanted prostheses (including breast implants) must be provided free of charge, but allow a fee to be charged for external prostheses.

Funding external breast prostheses through the Australian Health Care Agreements will complement the delivery of prostheses at the point at which the prosthesis becomes necessary - that is, after the mastectomy.

Negotiations for the next round of the Australian Health Care Agreements are currently underway and the new Agreements will come into effect on 1 July 2003 for a period of five years.

Today, Parliamentarians from all parties are wearing pink ribbons in the House of Representatives and the Senate to draw attention to Australia’s Breast Cancer Day, which will be observed on Monday 28 October 2002. Today is the last full Parliamentary sitting day prior to Breast Cancer Day.

Media Contacts Andrew Dempster 0407 435 157 (for Mr Smith) Amber-Jade Sanderson 0409 132 975 (for Dr Lawrence)

Fact sheets

Fact sheet 1: Breast cancer in Australia Fact sheet 2: Mastectomies in Australia Fact sheet 3: What women say about mammary prostheses Fact sheet 4: State arrangements for the provision of mammary

prostheses

Fact sheet 5: Funding of prostheses through the Australian Health Care Agreements

Fact Sheet 1

Breast cancer in Australia

• More than 10,000 Australian women are diagnosed with breast cancer every year.

• In 2000, 2511 Australian women died from breast cancer.

• Breast cancer is the third leading cause of cancer deaths and in women is the most common registrable cancer.

• The lifetime risk for developing breast cancer before age 75 is 1 in 11.

• The incidence of breast cancer has been on the rise since the early 1980s. However, death rates due to breast cancer have remained relatively stable over the same period, at around 22 deaths per 100,000 females.

Source: Australia’s Health 2002, Australian Institute of Health and Welfare.

Fact sheet 2

Mastectomies in Australia

• In 2000-01 in public hospitals there was a total of 4,112 procedures involving partial, subcutaneous, simple, extended simple, modified or radical mastectomies.

• In private hospitals the figure was slightly higher at 4,626 for these same procedures.

• Not all of these procedures led to the need to have an external prosthesis fitted.

• Table 1 provides figures and details of mastectomies after which a woman could need a prosthesis.

• Table 2 provides details of the number of breast reconstruction procedures carried out in 2000-01 in both public and private hospitals.

• In 2000-2001, 4252 women had a mastectomy and did not have reconstruction procedures.

• On this basis, it is estimated that around 4000 women require external mammary prostheses each year.

Table 1: Total Procedures 2000-01 Public Private

Simple Mastectomy 958 1017

Extended Simple Mastectomy 364 426

Modified radical Mastectomy 1311 1242 Radical Mastectomy 240 221

Total 2873 2906

5579

Table 2: Reconstruction Procedures 2000-01 Public Private

Reconstruction procedures on breast 475 852

Total 1327

Source: Australian Hospital Statistics 2000-01, Australian Institute of Health and Welfare, http://www.aihw.gov.au/publications/hse/ahs00-01/s04

Fact sheet 3

What women say about mammary prostheses

Mid forties, married with one child: “You have to put yourself on the backburner when you have other problems in your life. My daughter has needed a shunt in her head since she was four so she comes before me. The only way I can have a prosthesis is to make my own with bird seed and weight it with some fishing lead.”

Mid 30’s married with children: “I use rubber sponge from Clarke Rubber and cut it out to shape my bra. I know it can’t be right for me as I have so much neck and shoulder problems, but what can I do, we just can’t afford to buy another.”

Community Health Nurse (Extract from her consumer presentation in March 2001): “I would like to share with you something very close to my heart, (she then pulled out her prosthesis for all to see). Why if I required one, am I able to procure a glass prosthetic eye free of charge through my Health Service at $655 ever 2 years? Is it because it is cosmetic? Not only do I wear this Breast Prosthesis for aesthetic reasons, it is appropriately weighed for my posture and my balance. Many Rural women opt to go ‘without’ for financial reasons (travel costs included). In the year 2001 women are still wearing ‘footy socks’ in their bras or birdseed fill bags.”

Late 30’s, married with children: “Mum has lost both breasts and now I’ve had a mastectomy. I have four kids and can’t afford to buy anything as I am having treatment again for secondary cancer. I have been wearing mum’s old ones for some time now and yeah, it does fall out, but what can I do?”

Mid 40’s married with children: “We have private health cover but it only covers so much. When you have a family the area where it sits in that health cover gets used up so quickly, so I have no choice but to repair my old prosthesis, which as you can see, has the silicone seeping though the masking tape I have used. God, I am so embarrassed but that’s the way it is.”

Source: Caring for You, 2002.

Fact sheet 4

State arrangements for the provision of mammary prostheses

Under the current Australian Health Care Agreements, the States and Territories can charge for the provision of mammary prostheses and there is not an agreed standard throughout Australia.

New South Wales At the discretion of treating hospital. Women with a health care card can apply to have the cost of the prosthesis covered.

Victoria At the discretion of treating hospital. Application can be made to the Victorian Aids and Equipment Program, for a rebate on the cost of the prosthesis on the basis of need.

South Australia Initial prostheses are part of a woman’s overall treatment and no extra charge is incurred. For replacement prostheses funding of up to $250 can be obtained through the Independent Living Equipment Program for those with a health care card or concession card.

Queensland For women who have a health care card, initial and replacement prostheses are provided free of charge.

Tasmania Women are required to pay the first $50 towards their prosthesis and then the rebate is means tested against income. If they are eligible for a health care card or concession card then a maximum of $160 is available through the State’s Breast Prosthesis Scheme.

Western Australia At the discretion of treating hospital.

NT Public patients get their first prosthesis free. For subsequent prostheses, most women pay. Women can access donated stock, or get a discount and/or pay over time if they have financial problems or are pensioners.

ACT The ACT government pays $210 towards each patient's first prosthesis or $420 for women undergoing bi-lateral mastectomy.

Fact sheet 5

Funding of prostheses through the Australian Health Care Agreements

• Since it was established in 1984, Medicare has provided rebates for the provision of professional medical services by qualified medical practitioners.

• Medicare has never provided funding of physical aids or devices, including artificial limbs or external or internal prostheses of any description.

• The provision of prostheses generally has been provided for in the Australian Health Care Agreements.

• Negotiations for the next round of the Australian Health Care Agreements are currently underway and the new Agreements will come into effect on 1 July 2003 for a period of five years.

• The current Agreements require that artificial limbs and surgically implanted prostheses (including breast implants) must be provided free of charge, but allow a fee to be charged for external prostheses.

• Funding external mammary prostheses through the Australian Health Care Agreements will complement the delivery of prostheses at the point at which the prosthesis becomes necessary - that is, after the mastectomy.

• This will do away with the artificial distinction that currently requires States to provide reconstructive implants for free but allows hospitals to impose a fee for external prostheses.