CPAP Supplies Last Up To 4x Longer in Austrlia per ResMed - Or Is It That Allowed Insurance Replacement Rules Different?

Lane101 wrote: ↑

Wed Jan 11, 2023 11:11 pm

Did a quick search before posting on "Australia Replacement Frequency" and didn't come up with anything. Personally had not seen the Australian replenishment frequencies before.

Don't worry about it. There are a finite number of CPAP subjects, and many of them get circulated over and over here. It's a good thing as new members read. Your post is interesting.

ChicagoGranny wrote: ↑

Thu Jan 12, 2023 12:37 pm

Lane101 wrote: ↑

Wed Jan 11, 2023 11:11 pm

Did a quick search before posting on "Australia Replacement Frequency" and didn't come up with anything. Personally had not seen the Australian replenishment frequencies before.

Don't worry about it. There are a finite number of CPAP subjects, and many of them get circulated over and over here. It's a good thing as new members read. Your post is interesting.

Thank you. Seeing a leading manufacturer publicly validate what so many of us figured out on our own was eye opening. It should help folks feel more comfortable following a replacement cycle that makes the most sense for their personal situation.

I am gratified that my habit of using the same hose and tank for at least a year
is not a bad idea. I am encouraged that with a bit more cleaning, my pillows
can be used longer than they are used now.
My filters help with my allergies, and I feel best replacing them at 3 weeks.

Medicare set a minimum replacement frequency, ie, "we won't buy x any more often than y days/weeks/months", then the greedy DMEs in the US seized on that idea and said "if we tell people to throw away perfectly good stuff as often as we can bill medicare/insurance, WE'LL MAKE MORE MONEY.

Exactly.

However, Medicare didn't pull those replacement frequencies out of their butts. They got input--from the manufacturers and DME's. And other insurers fall in line with Medicare replacement schedules because they don't want to spend to do their own research, and face a tide of angry users who like to stockpile supplies and sometimes sell them.

Supposedly now Medicare requires the DME to document a problem before replacing equipment or supplies, but I suspect that's not audited too closely.

Janknitz wrote: ↑

Sun Jan 15, 2023 7:47 pm

Medicare set a minimum replacement frequency, ie, "we won't buy x any more often than y days/weeks/months", then the greedy DMEs in the US seized on that idea and said "if we tell people to throw away perfectly good stuff as often as we can bill medicare/insurance, WE'LL MAKE MORE MONEY.

Exactly.

However, Medicare didn't pull those replacement frequencies out of their butts. They got input--from the manufacturers and DME's.

I think that's highly unlikely.

Once again, Medicare does not suggest you replace things that often, they say that they won't pay for things any more often than that.

Curious if AU socialized medical system outlaws the “ask your doctor about x medication” type ads, full page print, and the rest of the direct to consumer marketing we have in the US.

???

Pharma spends $7-8 BILLION to market DTC but I’ve heard that where social medicine exists the DTC does not. Those costs are why we pay 3x as much (plus the middleman).

While cpap stuff doesn’t have DTC mktng they probably have the ability to secure at discount as a country. Kinda like what some in congress hope to do when negotiating lower drug costs for medicare patients in the US.

We don't have a "socialized medical system" such as the NHS in the UK. Our system is complicated and needs a lot of restructuring to become more efficient. Basically, under Medicare every Australian citizen is entitled to free medical and hospital care in a public hospital. However, the workload is extreme and waiting times have blown out to ridiculous levels. I had a post-covid complication which saw me waiting at the local hospital six hours until the nurse told me it could be another 4 hours before I was treated. I decided to go home and take my chances. So far I survived.

Medicare also covers a portion of the consultation cost for doctors visits and many procedures. Typically you'll go to the doc, hand over your Medicare and credit cards. The doc charges the maximum amount he can against Medicare and the balance against your credit card. So it's a co-pay system. Many doctors only charge the Medicare amount when treating kids or seniors, so the visit is effectively "free".

There is also a private insurance system, which is highly regulated. The huge advantage is that you can get seen by the doctor of your choice, not somebody allocated by "the system". Typically you'd be in a better standard hospital, though the differences are largely cosmetic. You can also get procedures done quickly - eg for something like a hernia or benign prostate the public waiting time can be a year or more, but under private insurance you can usually get it done within a couple of weeks. The cost of procedures is again split between Medicare and your private insurance. I had some recent surgery which included two nights in hospital and there was zero out-of-pocket.

In terms of pills and prescriptions, we have a centralised purchasing system called the Pharmaceutical Benefits Scheme (PBS). Under the scheme the federal government negotiates the price of drugs with the pharma companies, and subsidises drugs provided through pharmacies. There are a lot of discounts applicable (eg for seniors or concession-holders). If you or your family exceed a certain limit on drug costs in a given year, all subsequent prescriptions are free for the rest of the year. So a box of pills that nominally costs say $75 will be sold to Joe Public for $30. If Joe is eligible for a concession, he only pays $7.50. But if Joe and his kids have had a lot of sickness during the year, that box ends up being "free". The safety net arrangements come in at $262 for people on concessions and $1560 for the general public.

Off hand I don't know what if any rules apply to advertising drugs - it's not something I have noticed, but I watch very little commercial TV. I suspect the PBS structure makes it an unattractive option.

Information about the PBS: https://www.pbs.gov.au/info/about-the-pbs

Lane101 wrote: ↑

Wed Jan 11, 2023 4:31 pm

chunkyfrog wrote: ↑

Wed Jan 11, 2023 2:47 pm

Don't be ashamed of getting spares, because nobody is open at night,
when breakdowns ALWAYS happen.

an extra water chamber for each (per you post no one is open in the middle of the night if you drop one and break it),

OMG, so true! You cannot imagine my panic when I dropped the water chamber for my 2 week old Airsense 11 on the porcelain tile bathroom floor at 10pm Friday night! Fortunately, it was fine. Can't wait until hubby gets his machine so I will have a backup (he does not use humidification).

booksfan wrote: ↑

Mon Jan 16, 2023 9:16 am

Lane101 wrote: ↑

Wed Jan 11, 2023 4:31 pm

chunkyfrog wrote: ↑

Wed Jan 11, 2023 2:47 pm

Don't be ashamed of getting spares, because nobody is open at night,
when breakdowns ALWAYS happen.

an extra water chamber for each (per you post no one is open in the middle of the night if you drop one and break it),

OMG, so true! You cannot imagine my panic when I dropped the water chamber for my 2 week old Airsense 11 on the porcelain tile bathroom floor at 10pm Friday night! Fortunately, it was fine. Can't wait until hubby gets his machine so I will have a backup (he does not use humidification).

You can purchase an Airsense 11 humidifier water chamber for $25-$30 online if you want access to a backup sooner. As I've always purchased my CPAP machines directly from on-line vendors like CPAP.com I add a backup water chamber to the original order to ensure backup access in case the original breaks.

lynninnj wrote: ↑

Sun Jan 15, 2023 9:22 pm

Curious if AU socialized medical system outlaws the “ask your doctor about x medication” type ads, full page print, and the rest of the direct to consumer marketing we have in the US.

There are only two countries in the world that allow that type of advertising (US and I think Ireland or New Zealand)

Resmed is an Aussie company. They make stuff in Sydney. The Sydney made stuff is cheaper in Texas than Sydney.

I know people who make parts for the machines. They shouldn't cost more in AU.

-tim wrote: ↑

Mon Jan 23, 2023 8:53 am

They shouldn't cost more in AU.

The US market is ~13 larger than the Australian market. Quite apart from anything else, that has a big impact of retail pricing.

lynninnj wrote: ↑

Sun Jan 15, 2023 9:22 pm

Curious if AU socialized medical system

I don't know where you got that idea from, but it is essentially wrong.

The Australian healthcare system is sensibly regulated and there are public hospitals to provide a basic universal delivery capability, the VAST majority of healthcare delivery is carried out by for-profit clinicians/providers.

I’ve heard that where social medicine exists the DTC does not

In fact ony a tiny number of nations allow the sort of DTC you are referring to. It has nothing explicitly to do with the method of the healthcare delivery.

While cpap stuff doesn’t have DTC mktng they probably have the ability to secure at discount as a country.

In general, globally, theraputic devices exist in a quite different regulatory environment than theraputic drugs. Even when they are handled by a signle regulator, they really have very little of of significance in common.

-tim wrote: ↑

Mon Jan 23, 2023 8:53 am

Resmed is an Aussie company. They make stuff in Sydney. The Sydney made stuff is cheaper in Texas than Sydney.

I know people who make parts for the machines. They shouldn't cost more in AU.

In setting prices, cost is only one of a myriad of determining factors. Here is a quote from a brief article that only covers a few of the factors.

A firm also has to look at a myriad of other factors before setting its prices. Those factors include the offering’s costs, the demand, the customers whose needs it is designed to meet, the external environment—such as the competition, the economy, and government regulations—and other aspects of the marketing mix, such as the nature of the offering, the current stage of its product life cycle, and its promotion and distribution. If a company plans to sell its products or services in international markets, research on the factors for each market must be analyzed before setting prices. Organizations must understand buyers, competitors, the economic conditions, and political regulations in other markets before they can compete successfully.

https://open.lib.umn.edu/principlesmark ... decisions/

I'd like to turn the discussion around and ask about the American system. In another thread there was talk of going to the ED getting rapid service but costing huge fees. Is that typical? Are there free EDs for people who don't have insurance?

Here, EDs are part of the public hospitals and are free. (Though there are now some also attached to private hospitals, which charge ~$300). The problem with the free EDs is they are not staffed and equipped to handle the demand. I've had two recent occasions to visit the local ED and both times I ended up leaving without treatment, after waits of 6 and 5 hours respectively.

Respirator99 wrote: ↑

Tue Jan 24, 2023 8:30 pm

(Though there are now some also attached to private hospitals, which charge ~$300).

WIth the private hospitals, the fee is often rebated if you arrive in an ambulance. It is charged for walk-ins.

(For US readers AUD$300 is approximately USD$213 on today's FX rates).

The problem with the free EDs is they are not staffed and equipped to handle the demand.

That is pretty much the case for ED/A&E globally, whether free or not. It's just not possible level demand, so staffing is always problematic.

there was talk of going to the ED getting rapid service but costing huge fees

My most recent experience with a US ED was in NYC, pre-COVID, where I had twised my ankle.

The bill was approx USD$1500, but it was fortunately covered by travel insurance.