Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Saturday, July 15, 2017

Medical Priorities

"It's quite obvious that we could be utilizing those operating rooms for a longer period of time for performing medically necessary surgeries."
"All you have to do is look at the waiting list for surgeries."
Dr. Mitchell Brown, Canadian Society of Plastic Surgeons

"I can see how in certain segments of society [aesthetic surgery in public facilities] would raise eyebrows."
"I can also see this is a means for hospitals to raise revenue."
"Hospitals are pretty much all working in the red, and this is a source of revenue for them."
Dr. Brian Bottenberg, otolaryngologist/ear, nose and threat specialist, London, Ontario
In crunching the numbers of 1,109 patients with documented reasons for delayed surgery, the researchers found that almost a third of cases were delayed because of a lack of personnel. Trevor Lush / Post Media.  Patients whose emergency surgery is delayed are at a higher risk of dying, stay longer in hospital and cost the system more money, says a groundbreaking study at The Ottawa Hospital.
Are hospitals in Canada underfunded? The estimated health expenses in Canada are representative of 11.1% of the country's GDP, at $228.1 billion for a population of 36 million people, and a steadily growing cohort of the elderly.  Of that total expenditure, the majority is spent on hospitals, at 29.5%, while drugs take up another 16% and doctors' fees 15.3%, according to the Canadian Institute for Health Information in their latest, 2016 update.

Though health care spending is varied across the country, on average each of the provinces spends about 38% of their total budgets on health care. Per capita that comes out to $6,299 for all of Canada in figures representing the situation in 2016. The variances range from $5,822 in Quebec to a much higher $7,256 in Newfoundland and Labrador, according to the Canadian Institute for Health Information. 

The single most inefficient index of health care performance in Canada is long wait times for surgery. Some Canadians with health conditions requiring urgent amelioration wait months for medically necessary surgeries. Yet public hospitals country-wide are now revealed to be providing operating room space routinely for cosmetic, privately paid operations.
Are cosmetic surgeries done in public hospital operating rooms?
  • Health Sciences Centre, St. John’s — Yes
  • McGill University Health Centre, Montreal — Yes, very few
  • Jewish General Hospital, Montreal — No
  • Ottawa Hospital — No
  • Scarborough and Rouge Hospital, Ontario — Yes
  • Southlake Regional Health Centre, Ontario — Yes, 120 last year
  • London Health Sciences Centre, Ontario — Yes, 74 last year
  • Trillium Health, Ontario — Yes, less than 16 a year
  • William Osler Health Centre, Ontario — Yes, 150 a year
  • Sunnybrook Health Sciences Centre, Toronto — No
  • University Health Network, Toronto — No
  • North York General Hospital, Toronto — Yes, 168 last year
  • Winnipeg Health Sciences Centre — Yes, 10 a year
  • Saskatoon Health region — Yes, very few
  • Calgary health region — Yes, 110 a year
  • Vancouver Coastal Health — No
  • St. John Regional Hospital — No response
  • QE2 Health Sciences Centre, Halifax — No response
  • Mackenzie Health, York region, Ontario — No response

These would include breast enhancements, nose jobs, and a range of additional aesthetic, non-essential procedures carried out through daytime hours where the same facilities and support staff employed for heart bypasses or liver transplants are all deployed. In seven provinces 15 hospitals or health regions responded to investigative queries, to confirm that they permit some cosmetic surgery cases to take place in public hospitals.

What is revealed is that despite the immense and steadily increasing funding to hospitals through government support, that funding has proven insufficient to enable operating room hours to be expanded. The typical hours of surgical use for operating theatres is from 8 a.m. to 3:30 p.m. to enable medically necessary surgeries to take place, according to responses from these facilities.

The entire day is not, despite the crush of patients awaiting surgery of urgent dimensions, given over to public tax-paid operating room costs. Hospitals permit non-urgent, purely aesthetic, patient-paid surgeries to take place in those off hours, citing the fact that they do not affect wait lists, and help the hospitals' bottom line. Over 20 percent of "priority" treatments such as hip replacements see 20 percent of patients waiting longer than the recommended six months after seeing an orthopedic surgeon.

And while most hospitals charge patients having cosmetic surgery conducted in their operating rooms, the fees are evidently less than what private clinics with more limited facilities charge. The hospitals run the gamut from only a handful performed annually in certain hospitals to hundreds of non-essential aesthetic procedures taking place in hospitals that permit them. "NYGH (North York General Hospital) was not funded to run the operating rooms for the times that the (non-medicare) procedures took place, which allows us to make those ORs available" stated Nadia Daniel-Colarossi defensively where 168 aesthetic procedures took place in 2016.

She took care to stress that a total of 16,000 surgeries took place in 2016 at her hospital, placing the 168 cosmetic surgeries in some perspective. On the other hand, if the public funding were available to open up those ORs during unbooked times, that would represent 168 patients awaiting surgeries of an urgent dimension, having their necessary operations take place.

"These procedures are performed in otherwise unused blocks of operating room time", spokesperson Matt Haggerty of Southlake Regional Health Centre in Newmarket, Ontario, emphasized where 120 patient-paid cosmetic surgeries a year take place, representing close to one percent of the total surgeries undertaken there. And these numbers are reflected across the country in various public hospitals and other tax-paid institutions.

It seems clear enough that though hospitals claim the charges they levy help them cover general operating costs, they do not really reflect patients undergoing breast-lifts or stomach-tucks in such taxpayer-funded facilities compensating the public adequately, taking into account patients are attended by larger medical staffs and have access to more sophisticated equipment, in comparison to private clinics.

Even as Canadians still wait months for many medically necessary operations, public hospitals provide OR space for private, cosmetic surgery, the National Post found. Getty Images

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