Continuous Positive Airway Pressure Cost And Reimbursement Issues

In Australia, for the majority of those requiring it, the cost of CPAP is borne directly by the patient, or indirectly by the patient through his/her coverage in a health insurance fund. Such funds, and wherein medical devices such as CPAP are covered under the specific scheme, reimburse approximately 30% to 50% of retail cost. Percentage reimbursement can be significantly better, even 100%, in smaller "boutique" health insurance schemes. Approximately 43% of Australians (2006 statistics) carry some level of private health insurance.

Australian patients requiring CPAP who do not carry private health insurance must meet the full cost of purchase; costs approximate AUD$1300 to 1500 (CPAP machine, mask with tubing). Many patients will not readily acquire CPAP because of this financial hurdle. For impecunious patients requiring CPAP, there are schemes across all states in Australia, administered by state health departments through public hospitals, whereby after medical criteria for CPAP are seen to have been met, and there has been strict financial means testing, patients will be provided with CPAP equipment at subsidized cost (often the full machine costs are covered but "ancillary" equipment such as mask, tubing, humidifier, are not). Such schemes have a limited annually recurring financial budget, provide other medical devices against which CPAP provision must compete, and have a waiting time dictated by an available budget for CPAP under which these schemes may vary considerably from region to region. An analogous mixture of public and private purchasing of CPAP equipment, and most notable for controlled limited budgeting and regional variations of availability of supply and consequent waiting times for CPAP therapy in the public sector, applies in the United Kingdom and New Zealand.

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