Market Readiness for Provision of
Orthotist/Prosthetists: Supporting the Australian Community
Market Readiness for Provision of 1
Introduction
The Australian Orthotic Prosthetic Association (AOPA) is the peak professional body representing Orthotist/Prosthetists in Australia, with members comprising 80% of the practicing profession. AOPA is primarily responsible for regulating the profession and is a founding member of the National Alliance of Self Regulating Health Professions (NASRHP) in partnership with other professional organisations, including Speech Pathology Australia, the Australian Association of Social Workers and Exercise and Sports Science Australia.
Orthotist/Prosthetists assess the physical and functional limitations of people resulting from disease, illness, trauma and disability, including limb amputation, diabetes and neuromuscular conditions, such as Cerebral Palsy and Stroke. Orthotic and Prosthetic services may involve the provision of orthoses and prostheses to restore function, prevent deterioration, and improve quality of life. Orthotist/Prosthetists are commonly found in Australian hospitals, private clinics, research institutions and rural and remote regions, working independently and as part of multidisciplinary healthcare teams to support the Australian community.
AOPA welcomes the inquiry into the market readiness for provision of services under the NDIS and the commitment of the Joint Standing Committee on the National Disability Insurance Scheme to examine the impact of pricing on the development of the market. This submission illustrates a particular instance of pricing failure that has been inadequately addressed by the National Disability Insurance Agency (NDIA) and has the potential to lead to consequential market failure.
Contact
The Australian Orthotic Prosthetic Association
PO Box 1219, Greythorn, Victoria 3014
(03) 9816 4620
Luke Rycken – Policy and Advocacy Officer
Market Readiness for Provision of 2
Executive Summary
Orthotist/prosthetists currently operate under a more restrictive NDIS pricing framework when compared to similar allied health professionals. Appropriate pricing for orthotic/prosthetic clinical services is essential for the stimulation of the orthotic/prosthetic market and to avoid market failure in areas of poor geographical coverage, including rural and remote regions of Australia.
The most recent analysis of the orthotist/prosthetist workforce in Australia demonstrates a poor geographical dispersion of providers that may inhibit access to essential services for NDIS participants, particularly those requiring prosthetic services. Consequently, it is essential that unnecessary pricing barriers are addressed to ensure the market is able to function and NDIS participants residing in currently under-developed markets are able to access services.
Recommendation
The Australian Orthotic Prosthetic Association recommends:
- The Joint Standing Committee on the National Disability Insurance Scheme requests that the NDIA immediately address current pricing arrangements that inhibit the orthotic/prosthetic market.
Market Readiness for Provision of 3
NDIS Pricing for Orthotist/Prosthetists
The Productivity Commission Costs Position Paper identified that current pricing arrangements are excessive and benefit ‘some providers and participants over others’.1 This is particularly pertinent for the orthotic/prosthetic market, as under current price regulations, orthotist/prosthetists are subject to a lower price-cap when compared to other allied health providers. This is due to a change in the relevant provider registration group that has not been corrected by the NDIA.2 As a result, orthotist/prosthetists are relegated to a lower price-cap that represents a departure from the stated benefit of price regulations.3
This difference in price-caps may result in several outcomes. Orthotist/prosthetists may be less readily able to compete with other allied health professions when providing similar services. For example, both an orthotist and a podiatrist may readily provide a foot orthoses (or ‘foot orthotic’) to an eligible NDIS participant. However, where the orthotist provides the orthoses, they are restricted to a lesser clinical fee than the podiatrist performing the same service. This provides a significant financial and market detriment to orthotist/prosthetists. Additionally, consumers may experience detrimental consequences, as the market for applicable services is skewed towards those able to operate under the higher price-cap, despite no correlation in service quality between those able to operate under the higher price, and those operating under the lower price.
This pricing failure may similarly inhibit prospective orthotic/prosthetic providers from entering the scheme. Where providers identify that the scheme does not provide sufficient financial incentive to practice, or otherwise imposes price regulations that do not allow providers to operate effectively, they are less likely to join the scheme, effectively inhibiting the market. This is particularly pertinent for the orthotic/prosthetic workforce given the poor geographic dispersion of providers.4
1 Productivity Commission NDIS Costs Position Paper, 36.
2 See, AOPA NDIS Price Review Submission 2017. 3 Productivity Commission NDIS Costs Position Paper, 36. 4 Ridgewell, E. et al, (2016). Demographics of the Australian Orthotic and Prosthetic Workforce 2007-12. Australian Health Review,
40(5), 555.
Market Readiness for Provision of 4
The Australian Orthotic and Prosthetic Workforce
A recent analysis of the Australian orthotic/prosthetic workforce indicates that the Australian rate is well below international rates and the sole published recommended rate for orthotists, as indicate in figure 1.5 Additionally, the geographical dispersion of orthotist/prosthetists is of significant concern given no state or territory meets the recommended rates for optimal service provision.6 Furthermore only 15% of orthotist/prosthetists reside in rural and remote regions.7
This indicates that the orthotic/prosthetic workforce is particularly susceptible to market failure and steps should be taken to ensure that the market, particularly in rural and remote regions, is viable. As indicated by the Three Rivers Prosthetic Limb Funding Model Review, the ‘industry needs transparency and predictability and adequate funding to enable it to operate…and to remain sustainable into the future from a financial and workforce perspective’.8 Consequently, where insufficient price caps are imposed, providers find the provision of high quality services challenging when attempting to also recover their efficient cost. The outcome is a largely undeveloped market that does not encourage new providers to enter and limits individual
5 Ridgewell, E. et al, (2016).
6 Ridgewell, E. et al, (2016). 7 Ridgewell, E. et al, (2016). 8 Three Rivers Prosthetic Limb Funding Model Review (2011).
Market Readiness for Provision of 5
provider’s ability to offer high‐quality services within the pricing limits. This effect is particularly pronounced for the orthotic/prosthetic workforce given the small number of providers and poor geographical dispersion.
Outcomes for NDIS Participants
Where orthotic/prosthetic markets are underdeveloped, participants are unlikely to be able to access essential services. As an illustrative example, for amputees this may mean that they are unable to receive prosthetic services that would enable them to participate in the community and engage in work. In similar circumstances, NDIS participants may have to travel to alternate services, thereby increasing the effective costs for the scheme. Alternately, if orthotic/prosthetic services are not readily available, participants may delay seeking services, thereby reducing their ability to participate in the community and undermining the purpose of the NDIS.
Ultimately, an undeveloped orthotic/prosthetic market is likely to lead to limited access, reduced community and economic participation and additional costs for the scheme.
Recommendations
Current NDIS price regulations, subject orthotist/prosthetists to a lower price-cap when compared to other allied health providers. In combination with small provider numbers and poor geographical dispersion, this is likely to significantly inhibit the orthotic/prosthetic market, precluding access to essential services for NDIS participants. The Australian Orthotic Prosthetic Association recommends:
- The Joint Standing Committee on the National Disability Insurance Scheme requests that the NDIA immediately address current pricing arrangements that inhibit the orthotic/prosthetic market.