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Parent Section: A History of Day Surgery in Australia
Day Surgery Progress Stalls Last 12 Months
Over the past three years there has been increasing recognition of day surgery by the profession and politicians. A small number of very high quality day surgery facilities have been constructed throughout Australia however this activity appears to have stalled, to a certain extent, over the past 12 months and there are several reasons for this.
Probably the most important reason is failure of the health insurance industry and government to set sufficiently high, uniform benefits to ensure the viability of these facilities, especially in their earlier years of establishment.
Also, a full day surgery benefit, i.e. theatre fee and facility fee, is payable only for those patients insured in the higher tables of hospital insurance.
Another matter of considerable concern is a proposal by Dr Blewett and the Federal Health Department to categorise day surgery procedures.
"Some items would attract no benefit as they would be deemed capable of being performed in a Doctors Surgery" (Mr Peter Callanan, Federal Department of Health.)
The question is asked - deemed by whom?
A second list would also be compiled on the procedures which would only attract benefits following application to, and consent by the Department.
This purely bureaucratic economically based exercise is in total contradiction to a standard included in the Report and Recommendations of' the National Day Surgery Facility Standards Committee (Revised January, 1987) which stated: ) "A list of defined procedures suitable for Day Surgery is not recommended, but the suitability of the patients selected for the service is the responsibility of the surgeon and / or the anaesthetist."
The American College of Surgeons has also expressed concern at the rigid categorisation of day surgery procedures (vide infra) and when it is considered that approximately 500 procedures are carried out in day surgery centres (USA) any attempt at preparing lists of such procedures is as ludicrous as it is impracticable. Any list would be outdated before it is printed.
It is not suggested that some minor surgical procedures could not be carried out safely and expertly in doctors rooms, however the decision to do so must rest with the surgeon.
Such categorisation has no regard for the safety of patients nor the quality of patient care and the Federal Minister for Health should be held responsible for any patient suffering misadventure or injury as a result of being coerced to have an operation in a doctor's surgery on the basis of this categorisation and denial of benefits. Apart from the humanitarian aspect, the selective denial of benefits would appear to constitute 'insurance fraud'.
Day surgery would receive a significant stimulus if privately insured patients in all tables were eligible for the full benefit.
A decision by Medicare to subsidise disadvantaged patients for day surgery services would provide added support for the development of these efficient, cost effective facilities and, at the same time, help reduce the Federal Government's health care expenditure. The excellent article by Dr James Deves in "The Australian Surgeon" (August, 1988 edition) provided actuarial proof of the cost effectiveness of day surgery.
Although standards for day surgery, as published by the National Day Surgery Facility Standards Committee are, rightly, ambivalent concerning the siting of day surgery centres - free-standing, private hospitals, public hospitals - James Deves' paper provided compelling evidence that freestanding day surgery facilities were most economically efficient and cost effective.
It would appear that there has been some reluctance by surgeons and anaesthetists to provide the full support that day surgery deserves.
Certainly this requires a change from the well established patterns of' individual surgeons and anaesthetists practices and includes some "sharpening" of professional techniques to maintain the high quality of surgical and anaesthetic services, yet doing so in such a way that patients may safely return home on the same day.
The following article is reprinted from the May issue of the American College of Surgeons Bulletin (Volume 73 No. 5) and is a most important and instructive paper.
In part, it deals with the same concerns which have been addressed above and also records that as at February 1988 there are 838 Medicare certified freestanding Ambulatory Surgical Centres in the United States; most significantly, there were only 15 hospital based ASC's (vide infra).
Although not included in this article it is estimated that there will be 200,000 (approximately one-third) acute, overnight hospital beds closed in the US by 1990 as a result of the expansion of day surgery.
I understand that construction of a number of free-standing facilities in New South Wales is under consideration and these projects should receive the fullest support of the medical profession, government and all other interested parties in the provision of high standard, cost efficient surgical and anaesthetic services.