Introduction by Croakey: Efforts to ensure cancer patients have equitable access to much-needed prostheses are progressing intolerably slowly, says health policy analyst Charles Maskell-Knight.
While the problems around inequitable access and affordability have been clearly identified, and reform options have been put forward, Commonwealth Government processes are moving at glacial speed, with devastating consequences for many patients, especially those in regional, rural and remote areas, he reports.
The article also makes practical suggestions for generating some action from the Government.
Charles Maskell-Knight writes:
On 26 May, the Department of Health, Disability and Ageing (DHDA) posted on its website the report of an Independent review of cancer prostheses equity in Australia carried out by KPMG under a contract worth $229,000.
The report was completed on 29 August last year.
The review followed the report of a Senate inquiry into equitable access to diagnosis and treatment for individuals with rare and less common cancers, including neuroendocrine cancer, tabled in May 2024.
Recommendation 14 from that inquiry was “that the Australian Government work with state and territory governments to identify the barriers faced by cancer patients requiring rehabilitation, prosthetics and implants as a result of their treatment, with a view to ensuring they have financial support for those services”.
The recommendation emerged from evidence that “cancer patients who require oral and maxillofacial rehabilitation, including prosthetics, following treatment for head and neck cancers, must fully pay for these procedures”.
In its response to the inquiry (tabled on 28 August 2025, 15 months after the report) the Government expressed “support in principle” for the recommendation.
It said that the then Department of Health and Aged Care had “engaged a service provider to lead an independent review of cancer prostheses equity in Australia [which would] examine the availability of Commonwealth, state and territory prostheses programs, current challenges for cancer patients to access prostheses, develop strategies to address identified gaps and barriers and help find appropriate funding options”.
It is an interesting commentary on the glacial speed of Government responses to Senate inquiries that the KPMG review was apparently finalised the day after the response was tabled.
The basic problem the Senate inquiry was trying to address is that Medicare and the public hospital system will pay for surgery for head and neck cancers to address the cancer. But patients are often left with facial disfigurement, oral or dental dysfunction, or loss of voice, and the system will not pay for the prostheses needed to address these concerns, and which may cost tens of thousands of dollars.
There are about 6,000 cases of head and neck cancer annually, and about five percent of cases will need a prosthesis after surgery.
Findings
While the committee recommendation emerged from evidence about head and neck cancers, DHDA commissioned KPMG to take a much wider view and examine external breast prostheses, artificial limbs, and other prostheses, including voice prostheses, in addition to head and neck prostheses.
The review found a mishmash of inconsistent and inequitable access to prostheses schemes funded by different agencies, summarised as:
- There is no national program or scheme currently in place for individuals requiring a facial prosthesis due to cancer or cancer treatment, although some publicly funded facial prostheses services are available in Victoria, Queensland, WA and the ACT
- The Commonwealth funds breast prostheses through the External Breast Prostheses Reimbursement Program, and additional breast prostheses supports are provided by non-government organisations in some jurisdictions including NSW, Queensland, and SA
- Eligible people can access limb prostheses through the NDIS, while ineligible people can access state and territory-funded artificial limb schemes, which vary significantly by jurisdiction, including differences in funding allocation, treatment approaches, prosthetic componentry and consumables provided
- People in rural and remote areas often rely on mobile services, online retailers, or are required to travel to access services in metropolitan or interstate locations
- Except for Department of Veterans’ Affairs services, there is no national program for people requiring voice, male reproductive, or oral prostheses, and publicly funded support varies significantly across jurisdictions, leaving many individuals to cover the full cost of these prostheses.
The review also found barriers to access including:
- Unclear care pathways and system complexity, a lack of awareness of existing services and schemes, and issues relating to eligibility criteria for existing schemes
- A lack of services, particularly in regional, rural and remote areas, long wait times to access services, and limited availability of culturally safe and accessible prostheses services for Aboriginal and Torres Strait Islander and culturally and linguistically diverse communities
- A shortage of skilled prosthetic providers, particularly for facial prostheses, no clear or formal education and qualification pathways for providers of facial prostheses, and a lack of regulation and accreditation standards for providers of facial prostheses
- Out-of-pocket costs for prostheses not covered by existing schemes, upfront payments required under existing reimbursement models, and travel costs for patients who cannot access prostheses services where they live.
Options
The review identified three options for improvement:
- A national program to provide funding for facial prostheses that are required as a result of cancer or cancer treatment at a cost of $51.6 million over 10 years
- A national program that, in addition to the funding provided under option 1, also provides funding to ensure individuals requiring an external breast prosthesis as a result of cancer or cancer treatment are not required to make an upfront payment. This would cost $123.4 million over 10 years.
- A national program that, in addition to the funding provided under option 2, also provides funding to ensure that individuals aged 65 years and older who require a limb prosthesis as a result of cancer or cancer treatment can access a prosthesis that meets their needs. This would cost $209.8 million over 10 years.
Sector reaction
Croakey approached a number of health sector groups asking for their reaction to the review report.
Head and Neck Cancer Australia (HANCA) CEO Nadia Rosin said: “This review reflects what patients have been telling us for years – access to facial prosthetics for people who have had life-saving head and neck cancer surgery in Australia is inconsistent and too often depends on where you live and what you can afford – it’s effectively a postcode lottery.
“We’ve had nationally supported access for breast prostheses since 2008, people with head and neck cancer deserve the same standard of care.
“This isn’t about appearance – facial prosthetics are essential survivorship care. They restore function, dignity and quality of life after cancer treatment, and people should be able to feel confident in who is delivering that care through clear standards, accreditation and training.”
Rosin said a clear plan and a timeline was now needed: “This is a chance for the Government to deliver on the equity commitments in the Australian Cancer Plan and ensure fair access to care for people who’ve already been through so much.”
Rosin said HANCA was calling on the Government to:
- Provide a formal response to the KPMG review, including a clear implementation timeline
- Establish a national scheme to deliver equitable access to facial prosthetics for people affected by head and neck cancer
- Introduce nationally consistent accreditation, training and quality standards for prosthetic providers to ensure safe, high‑quality care
- Commit to transparent reporting and accountability measures to track progress.
The National Rural Health Alliance told Croakey: “It is not unsurprising… [that the review] highlighted fragmented state schemes and massive financial burdens for rural, remote and regional Australians who face prohibitive travel costs and limited access to specialised health services.
“Living outside major metropolitan areas exacerbates these issues across several dimensions, including having to relocate for longer periods of time for surgery and fittings, away from family, friends and work which add to stress, travel and accommodation costs.
“The states chose to pay well and truly below cost and take up to nine months to reimburse, so people give up. As if rural patients don’t have enough to tend with already, begging for reimbursement or subsidy… is just another straw that will break the camel’s back.
“Rural and remote communities face inconsistent out-of-pocket pricing and confusing eligibility rules, many chose not to seek treatment or delay due to these challenges.”
The NRHA said “rural communities don’t need more reviews, Senate enquiries and policies”. The Government needs “to ensure that rural people can live in dignity and with the same access urban people can have,” the Alliance said. “Easy to utilise, national access and funding schemes are a start, to ensure coverage doesn’t depend on a patient’s postcode.”
Government (in)action
During the 2025 election campaign, the ABC reported Minister Mark Butler as saying the Government had launched an independent review into the availability of prostheses programs to identify gaps in coverage, and that he expected the review to be completed in July.
Six months later, on 28 October 2025, the issue was raised on the ABC 7.30 Report.
During a media conference several days later, Butler was asked: “Oral cancer survivors spoke of having to make the choice to re-mortgage their homes to pay for dental prosthetics or to go without teeth. Do you think it’s fair for cancer patients to have to make this choice going without their home or teeth?”
He replied that the report “follows an inquiry that the Senate did recently into rare cancers… [including looking at] the impact of oral cancer in particular on jaws and teeth, and the need to think about our prosthesis schemes that help people recover after that sort of surgery… We initiated a review after that Senate inquiry to scan the different schemes that state governments by and large operate across the country.”
He said the Department was in the process of finalising advice based on that review. “And I look forward to working with patient groups and some of the really hardworking clinicians who’ve been making this case to see what we can do in the future to support those people better,” the Minister said.
Seven months have now passed since those remarks.
I asked DHDA:
- Why it took nine months to publish the review report?
- If it had provided the advice as foreshadowed by Butler?
- What was the future process and timetable for dealing with this issue?
DHDA responded:
- The Department accepted the final report on 30 September 2025 and provided advice to the Australian Government in late 2025
- As most findings fall within state and territory responsibilities, advice was informed through extensive consultation with jurisdictions. Consultation was also required across several Australian Government portfolios
- The Department has written to jurisdictions to advise of the publication and will continue to progress implementation discussions directly with state and territory governments
- The Australian Government recognises the importance of equitable access to prostheses for cancer patients and continues to work with key stakeholders to understand patient experience, access barriers and implementation considerations.
After reading this response, it is still not clear why, if advice was provided to Government in late 2025, the review report could not be published until the end of May 2026.
While many of the findings are about inconsistencies in state and territory schemes, the options identified by the review are for action by the Commonwealth Government.
The review clearly spells out “patient experience, access barriers and implementation considerations”.
What more work does the Government need to carry out to improve its understanding? Which bit about people dipping into their superannuation or increasing their home mortgages to fund prostheses does the Government not understand?
And finally, the response from DHDA does not provide any indication of a timetable – presumably because the Government intends to kick this can down the road for as long as possible.
The Government is prepared to spend hundreds of millions of dollars a year on adding new drugs to the Pharmaceutical Benefits Scheme to improve cancer outcomes. But it is not prepared to spend $20 million a year to address loss of function or disfigurement in people who have survived cancer surgery.
Cancer patient groups have been pursuing this issue for some time, and do not appear to be gaining much traction.
I think it is time for major medical organisations to take up the cause. If the Australian Medical Association, the Royal Australasian College of Surgeons, and the Royal Australasian College of Dental Surgeons get together, they will collectively have a great deal of influence.
Perhaps the Opposition could adopt introduction of a scheme as a policy for the next election – and shame the Government into following suit.
Or perhaps the Greens could take up the cause, and use it as a bargaining chip with the Government in a deal to get other legislation passed.
Author details
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media. Follow on X at @CharlesAndrewMK, and on Bluesky at: @charlesmk.bsky.social.
See Croakey’s archive of articles on cancer
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