Starting this week, private health insurers are prohibited from providing benefits for a number of natural therapies. This understand aromatherapy, western herbalism, homeopathy, naturopathy, pilates, reflexology, Rolfing (soft tissue manipulation), Shiatsu, tai chi, yoga and half a dozen others.
The purpose of these changes is to prevent taxpayers from subsidizing these therapies. But the way the changes were legislated will have many unintended consequences.
Why have some therapies been removed?
The therapies were removed after a 2013 government review could not find significant evidence of the clinical effectiveness of these therapies.
Based on the review, a ministerial committee concluded that these therapies should no longer attract taxpayer subsidies under private health insurance.
Taxpayers subsidize natural therapies through private health insurance reimbursement, which covers about 25% premium cost.
This discount itself is controversial. It costs the government about $6 billion a year and many specialists questioned whether this was an efficient use of taxpayers’ funds.
However, current government policy is to subsidize premiums. So ensuring taxpayer dollars are focused on therapies that work is a laudable goal.
How does the law prohibit therapies?
Government subsidies for private health insurance premiums are governed by legislationwith practical considerations fleshed out in regulations. Government subsidy exclusions would typically be incorporated into these mechanisms.
Instead, the change is contained in a separate set of rules that govern what insurers can offer. Three rules have been amended:
Chinese medicine, chiropractic and massage therapy are not listed and may still attract private health insurance benefits.
The 2013 review noted evidence for some of the natural therapies on the list, but excluded them because they were limited to specific conditions or situations. Evidence of the Buteyko breathing technique, for example, limited to asthma.
This limitation may justify a restriction of direct benefits. However, the legislation requires that any package of care or asthma management program that attracts benefits specifically excludes Buteyko, even if the insurer does not pay Buteyko directly.
Organizations can still technically offer these services if they are completely separated clinically and administratively from the reimbursable elements. But the reality is that it creates an almost impossible barrier. Natural therapies on this list can no longer interact, interface or integrate with reimbursable services.
The Ministry of Health private health insurance advisor admitted as much, noting that it would be nearly impossible for insurers – or organizations accepting insurance – to overcome the hurdles and offer natural therapy services.
If the legislation had focused on removing subsidies, there would have been few problems. But the legislation’s “prohibitive list” is highly unusual.
If the therapies work, won’t they be allowed to come back?
The changes have a number of structural issues.
There is no formal process for updating the list as the evidence evolves. This means that the therapies remain prohibited until otherwise legislated and that other therapies cannot be added easily.
By virtue of not being included in the list, reiki and crystal healing are eligible for benefits.
In the meantime, the review is already outdated. It looked at systematic reviews published between 2008 and 2013 and did not look at original research at all. The search criteria for the review were narrow and may not reflect practice. The review excluded evidence for individual herbal medicines, for example, because it did not believe these data were relevant to the practice of herbalism.
Meta-analyses now show that yoga is effective in conditions such as Diabetes and Back ache. Yoga is now recommended as first-line treatment for low back pain United Kingdom. And NATO recommends military health services use yoga for post-traumatic stress disorder and back pain.
This legislation makes similar programs almost impossible to replicate in Australia.
At the very least, the Department of Health should update the review to ensure that evidence on which they based this decision is common.
We need an evidence-based approach to natural therapies. But these changes impede access to therapies that are known to work, encourage therapies that are known not to work, and reduce the ability of researchers to study what works and what doesn’t.
*The author’s statement has been updated since this article was first published.
