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Health Insurance, Medicare Benefits Schedule (MBS) & Podiatric Surgery

In April 2007 the Federal Health Insurance Act was amended to allow Health Funds the ability to design more flexible insurance products.

Previous federal legislative reform (2004/5) was specifically intended to encourage appropriate recognition of podiatric surgical services and equitable payment of rebates for these services. The Health Insurance Act and the National Health Act were amended to include Members of the ACPS in the same category as medical practitioners for the purposes of hospital admission. The explanatory memorandum to the amendment stated that hospital treatment provided by Members of the ACPS should be treated under applicable benefits arrangements “as they would if a medical practitioner provided a professional service”. These legislative reforms in combination with the national registration of Members of the ACPS as specialists in foot and ankle surgery affirm that surgery performed by Members of the ACPS has been shown to be safe, clinically effective and cost-effective.

The ACPS conducts an audit program, in which participation is a requirement of membership. The audit program aligns with the Australian Council on Healthcare Standards (ACHS) input and clinical indicators. Our outcome data shows that complications (as defined by ACHS definitions) are either within or below the rates that are reported in the literature1-6.
No individual or organisation should imply or suggest that the training and or skills of podiatric surgeons in Australia are in question, with outcome data supporting the safety profile of Australian Podiatric surgeons.

Medicare funding parity for podiatric surgery is crucial for ensuring equitable access to high-quality care for all individuals, especially vulnerable populations, remote communities, and Indigenous First Nations health. By granting MBS funding parity, the government recognises the vital role that podiatric surgeons play in addressing foot and ankle conditions that disproportionately impact these communities.

Many vulnerable individuals, including the elderly, individuals with chronic health conditions, and those with limited mobility, rely on podiatric surgeons to alleviate pain, improve mobility, and prevent further complications. MBS funding parity would enable these individuals to access specialised podiatric surgical interventions without financial barriers, promoting their overall well-being and quality of life.

In remote communities, where access to medical specialists can be limited, podiatric surgeons are critical in providing essential foot and ankle care. MBS funding parity would help bridge the healthcare gap by ensuring that individuals in these communities have access to the same level of specialised surgical interventions as their urban counterparts, reducing health disparities.

Furthermore, MBS funding parity is particularly important for Indigenous First Nations' health. Indigenous communities face higher rates of foot-related conditions and complications, often stemming from historical and social determinants of health. Granting MBS funding parity for podiatric surgery acknowledges the need for culturally appropriate care and ensures that Indigenous individuals have equal access to specialised foot and ankle interventions, contributing to improved health outcomes and addressing health inequalities.

Additionally, by granting MBS funding parity, the government recognises that individuals should have the freedom to make informed decisions about their healthcare and select the most suitable provider based on their specific needs and preferences. This autonomy of choice empowers health consumers to actively participate in their own care and promotes patient-centred decision-making. By recognising the autonomy of health consumers in selecting their service providers, MBS funding parity for podiatric surgery aligns with the principles of patient-centred care and fosters a healthcare system that values individual choices and preferences. Foot and ankle surgery is a specialised field, and podiatric surgeons bring a unique set of skills and expertise to the table. Recognising the importance of autonomy in healthcare decision-making, MBS funding parity allows individuals to access the specialised services offered by podiatric surgeons without financial barriers.

A link to our publicly available audit outcome data can be found here


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Hospital Costs

To satisfy the intent of federal parliament when passing the legislation, health funds should consider equitable payment of hospital costs; including theatre costs and prostheses costs in association with admission for foot & ankle surgery performed by registered specialist Members of the ACPS. Many insurance companies comply with this intent – if your fund however discriminates against Members of the ACPS by not providing a product that equitably covers these costs you should consider firstly discussing the issue with your fund and if no positive outcome is noted you may complain to the Health Insurance Ombudsman. Please note that many services are only available on higher levels of hospital insurance. You may not be eligible for payments for podiatric services based on the level of coverage you have paid for.

Podiatric Surgical Fees and Anaesthetic Fees

Despite there being no current Medicare benefit for podiatric surgery, under the new legislative arrangements insurance companies have the option of offering an insurance product that covers these fees. This is the same discretionary power the funds have for any provider.

In Australia, private health insurance companies are under no obligation to pay for podiatric services and associated hospital costs. However, many do, and they all have the choice to do so (as is the case for dental and medical procedures). This includes surgical procedures performed in hospitals. Some health funds have demonstrated little understanding of the needs of their clients. If you find your fund does not cover podiatric surgery, you can change your health insurance to one that does choose to cover some or all of this service, lobby your fund to change its policy and/or provide you with what is called an “ex-gratia” payment.

If you are told they cannot pay as the service is not Medicare rebated it is important to realise that this is an internal fund policy that can be changed if clients apply pressure. Such a position is in contradiction to the intent of the Federal Parliament. To facilitate change in the attitude of such health funds it is essential that you complain to the Private Health Insurance Ombudsman and your local member of parliament.

To make a complaint regarding funding inequality relating to podiatric surgery, contact the Commonwealth Ombudsman at www.ombudsman.gov.au or call 1300 362 072.

For general information about private health insurance, see www.privatehealth.gov.au

  1. Wukich DK, Lowery NJ, McMillen RL, Frykberg RG. Postoperative infection rates in foot and ankle surgery: a comparison of patients with and without diabetes mellitus. Journal of Bone & Joint Surgery, American Volume. 2010;92(2):287-95.  10. 
  2. Butterworth P, Gilheany MF, Tinley P. Postoperative infection rates in foot and ankle surgery: a clinical audit of Australian podiatric surgeons, January to December 2007. Australian Health Review. 2010;34(2):180-5.  11. 
  3. Borg A HH, Hinterman B,. Risk factors for symptomatic deep-vein thrombosis in patients after total ankle replacement who received routine chemical thromboprophylaxis. Journal of Bone and Joint Surgery. 2011;93B(7).  12. 
  4. Jameson S AA, James P,. Venous thromboembolic events following foot and ankle surgery in the English National Health Service. Journal of Bone and Joint Surgery. 2011;93B(4).  13. 
  5. Radel R KN, Aigner C. Venous Thrombosis After Hallux Valgus Surgery. Journal of Bone and Joint Surgery. 2003;85(7).  14. 
  6. Solis G ST. Incidence of DVT following Surgery of the Foot and Ankle. Foot and Ankle International. 2002;23(5).