‘Potentially conflicting interests’ – health insurers push back on product ‘techs’ in operating theatres
Surgeons say their operations run more smoothly with a product specialist in the room, but health insurers question their role in theatre.
Surgeons say their operations run more smoothly with a product specialist in the room, but insurers are not so sure they are an essential part of the theatre team.
Private Healthcare Australia, the peak body for health funds, has long questioned the presence of product specialists, also known as in-theatre technicians or orthopaedic med-tech company representatives, in an operating theatre.
So it was no surprise when they responded strongly to The Australian’s “explainer” about the product specialists who were employed by device-makers and distributors to help theatre staff with the increasingly hi-tech implants used in many procedures.
The PHA’s key claim is that there is a risk some technicians are involved in “upselling” prostheses and other devices while in the theatre.
That’s a claim strongly rejected by surgeons we spoke to for our story and by the peak body for manufacturers, the Medical Technology Association of Australia.
MTAA chief executive Ian Burgess says the claim theatre techs are engaged in sales activity during operations is “false, misleading and offensive”.
“Attempts by insurers to draw misleading links between theatre support roles and sales commissions appear designed to undermine trust in the clinical team and distract from their own egregious behaviour,” he tells The Australian.
But PHA chief executive Rachel David says the medical device industry is a multibillion-dollar sector in Australia and there is competition for market share.
She says sales representatives typically work off commissions with incentives to increase the volume of products used and the use of more expensive devices.
Medical technology companies build relationships with health professionals to promote sales, via company-sponsored educational events or paying for travel for speakers at conferences.
Leading orthopaedic surgeon Michael Solomon says it’s wrong to suggest product specialists are “upselling” in the theatre, and that if a company representative wanted to demonstrate a new implant they would make an appointment to see him in his office.
The private health funds, private hospitals and manufacturers are involved in arguments about the costs of operations – such as hip and knee replacements – with insurers keen to cut inpatient rehabilitation and the cost of implants.
The PHA’s opposition to product specialists in theatres is one element in the debate about increasing costs.
Product specialists assist nursing staff during procedures but are not permitted to touch patients. They have a key role in maintaining inventory, and ensuring all implants and instruments are in place for each operation.
But David argues all patients should be made explicitly aware of any non-hospital personnel in their operating theatre.
She says the involvement of some assistants in hospital purchasing processes mean they have “potentially conflicting interests: working as a commissioned sales representative while also providing advice on medical treatment”.
The system creates ethical concerns about the impacts on healthcare costs, the outsourcing of expertise, and issues of accountability and informed consent, David says.
“While medical devices representatives have a role to play, there is not enough scrutiny and oversight of their activities,” she says.
“There is no ACCC-supervised medical device code of conduct like there is for the pharmaceutical industry and medicines.”
Matthew Koce, chief executive of Members Health, which represents not-for-profit and member-owned health insurers, says “unlike pharmaceuticals, there is no legislation banning rebates or other financial incentives being shared between medical device companies, hospitals and clinicians”.
“Addressing that should be the No.1 priority for government,” he says.
“It is way past time for legislation mandating full transparency for consumers and the banning of rebates or undisclosed financial incentives.”
Burgess argues that while the med-tech industry – which is subject to price regulation by the federal government – has delivered savings, these have not been passed on by the funds.
“Since 2017, the medical technology industry has delivered $3bn in direct savings to corporate health insurers through benefit reductions,” he says.
“Yet not a single dollar has been passed on to patients or failing private hospitals.
“Instead, insurers have pocketed the entire $3bn – diverting it into record profits, increasing by $1.4bn (56 per cent) in the last two years and soaring management expenses which increased by $1.13bn (50 per cent) in the five years to June 2024.
“Corporate health insurers’ attacks on in-theatre technicians are yet another attempt to further line their own pockets at the expense of patient outcomes, surgical safety and clinician choice.”
Helen Trinca was operated on by Dr Solomon in November 2024.
To join the conversation, please log in. Don't have an account? Register
Join the conversation, you are commenting as Logout