Too many unnecessary surgeries in Canada? - Macleans.ca
 

Too many unnecessary surgeries in Canada?

Report: Canada could save millions by reducing potentially unnecessary surgeries


 

An annual report by the Canadian Institute for Health Information (CIHI) found that Canada could save up to $180 million a year if doctors consistently offered the most appropriate and most cost-effective procedures to their patients, and put fewer people under the knife by reducing the number of potentially unnecessary surgeries done in the country each year. The report found discrepancies in the number of caesarian sections and hysterectomies performed in Canada, suggesting some of those procedures are not needed. For example, last year, Ontario’s rate of first-time caesarian sections was 19.6 per cent of all deliveries; if that rate could be lowered to match Manitoba’s rate of 14 per cent, the lowest in Canada, Ontario would do 7,200 fewer surgeries and save $16.2 million. The report also showed that too many procedures are still being done despite evidence that indicates they don’t help patients, such as surgery for knee pain.

Toronto Star


 
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Too many unnecessary surgeries in Canada?

  1. I can see how studies and augmentations to the health system could help us manage costs, and I get the necessity of such cut backs with Canadas growing elderly coupled with a small new generation forced to bear the weight of sky rocketing health costs. But this is a very fine line…A doctors responsibility is not to the dollar, its to the patient. If we wanted doctors and coverage providers that are focused on the financial cost we would have a private dominated insurance sector like the states.
    What we need is radical reform and strong emphasis on preventative medicine and procedures like the NHS.

  2. Of course regional variation is an opportunity to conclude that unnecessary procedures are likely happening.

    BUT: On what grounds does the CIHI proclaim that the province with the LOWEST rate of a given procedure has, by definition, the appropriate rate? Maybe even that low rate is unnecessarily high? Or maybe that province is putting patients at risk by not doing more?

    • Yes, it does seem like a somewhat arbitrary and superficial approach to simply conclude that the regon with the lowest rate is doing the best job at balancing costs vs needs.

      • Some deeper digging should be done to determine if Manitoba is being too risky. If it isn't, then at least hed in that direction.

        • It is also possible that they do not have the operating room time available; enough surgeons to perform some of the less urgent surgeries – ie: hysterectomies.

          • Sure, that could also be a part of the explanation, or the entire reason for that matter – the answer would be good to know.

  3. Next can we have the stats of failures in the operations done? I say its over 50%!

    • Based on your intimate knowledge of the health care system? Or just a wild guess?

  4. $180 million seems like a paltry saving in a nation with 32 million people, all covered by healthcare. $16 million on c-sections? The figures themselves don't scream waste.

    • Really! The incorrect prescriptions for acid reflux or heartburn alone is costing billions. Walmart, USA sells the best for the less, no prescription. How come I sure have no idea?

      • First, you want to get checked out to make sure what you are experiencing is in fact acid reflux and not something heart related. Also, if you have had the complaint for quite awhile, you might want a scope to make sure you don't have esophageal cancer. Acid reflux is also a common cause of asthma (related to inhaling the acid that keeps coming up) so if you have a persistant cough, you might see a doctor about that. Now, as to buying your acid reduction medication at a store without a prescription..the one they sell is a generic brand call Ranitidine and it is great IF it works for you. If you still have persistant gut pain and acid backing up, you made need the stronger medications, which are newer and available by prescription only.

  5. 1) Canadians need to take more responsibility for their own health.
    2) Hospitals need to be more cost-efficient, i.e. manage money better, and keep an eye on ''executive salaries'' which seem to be waaaay out of control in every organization. (The CEO of the Halifax Water System wanted a 40% pay increase, and his henchmen wanted 20%!!)
    3) The RN's society has a stranglehold: too many highly-educated nurses just doing paperwork and not deigning to do the scut work. We need to hire more RNA's. They do the real legwork.
    4) Maybe the high-risk sport people need to pay a fee for all their broken limbs needing surgery, casts and physio…?
    5) More supervision of decisions to do surgeries on people so aged that their bodies can't recuperate from things like hip replacement, etc…

    All in all, just a little more common sense would do the system good!

    • You are absolutely right in that Canadians do have to take more responsiblity for their health. However, some of your other points are a bit misguided. The registered nurses do have to chart the assessments and interventions they do for each patient under their care. This is not only for legal reasons but it also communicates to the doctor and other members of the health team how the patient is progressing. Registered nurses in Canada enter university with very high marks, often an 85% average, higher than engineering students and sometimes medical students. They study intensively and attend clinical training for four years. They do much of the cleaning up of bodily fluids. They also run epidurals, central lines and evaluate heart monitors. They are the eyes, ears and minds of the physicians who spend very little time with each individual patient. They are taught to think critically so they can not only do assessments but figure out what it means and what the next step should be in keeping a patient well. They advocate on behalf of the patient to the physician. I do not think you want less of these highly-educated individuals in the hospital. They are a real "steal" at $40.00 and hour.

  6. As a Canadian and a nurse practicing in the US,
    I can tell you that doctors in Canada don't do half as much as they do in the United States.
    What this article is trying to point out I think, is that
    Canada's Medicare doesn't want to do certain surgeries because they are too expensive. And eventually Canadians one day will end up paying the bill.

    • No. This article is actually suggesting a combination of things.
      One, docs are comfortable doing things the way they always do.
      Two, no national standards exist for surgical procedures. Some provinces have committees that evaluate procedures based of effectiveness, some don't.
      Three, a lot of Ob Gyns get pushed by mothers to deliver to a preferred schedule.

      In some cases, doing the more expensive surgery saves money, as it mans less complications, no "do-overs" and a better patient outcome (eg, no readmission).

    • A heart surgeon in Canada does about 2 surgeries a day, about 200 surgeries a year. A US surgeon does 80 surgeries a year. The reason is that the latter makes more money.

      • Linda, there are different kinds of heart surgerical procedures and different classes of heart docs that perform them. Interventionist Cardiologists insert pace-makers and do angio-plasties, which open vessels – several are done a day. These are very different from the work done by the Cardiac Surgeon who does the cardiac artery bypass graft (CABG), which is open-heart surgery. I did some research and 3.4 (3 fulltime/1half time) cardiac surgeons in a typical Canadian cardiac centre perform between 300 and 700 surgeries per year as a team, each taking turns. They are long, exhaustive surgeries. No one is doing two per day.

  7. I have been, informally, keeping track of births among my cohorts. By my math, C-sections are at or very near the majority of births. It is a surprise to me when I hear of a natural birth.

    This is very wrong.

    • Well, there may be something to that. My understanding is that once you've had a C-section, all your babies will be born that way. I'm sure there are a lot of reasons for a woman to require a C-section (small birth canal, heart defect) but just because your first child was in a breech position, that means all your children must be born that way, even if not in a breech position? I don't get it.

      • I don't get it either. As I said, it was an informal survey. But you'd think that hearing about a C-section birth would be more of a surprise than it has seemed to me. I suppose I should think nothing of it, as I only have anecdotal evidence of a problem.

        • Friend of mine is an Ob Gyn. He tells me a lot of women come in with a series of days that would be their "first chioce" to deliver. He said it's been increasing since the late 90's to the point where he's dropped patients who insist on a C-section when it's not necessary.

          He also reports that many of his colleagues just go with the flow, get informed consent and let the patient win. Who wants a fight?

          • I do not know why I am reacting so shocked to this issue. I have probably hobbled myself with archaic notions of right and wrong.

      • In some cases a C-section is required if you have already had one – it depends on the type of incision that was done during your first C-section ( on the uterus). If there is a large incision, the uterus can't handle the stress of labor contractions and may rupture causing the mother to hemmorhage and the babe to die.

        • Hey, thanks for explaining that! Good to know.

    • I know of a close friend who nearly lost her life when giving birth because the obstetrician was trying to avoid a C-section; the hospital has a goal of reducing C-section.

      • So, are you saying that all births – to avoid risk – should be done by C-section? Are C-sections risk free?

        Does this in anyway invalidate the point that I was making? Especially when I said I didn't understand why it was happening so frequently. I do not think that your comment contributes towards clearing up my confusion.

        Never the less, I thank you.

        • No of course C-setions are not the way to go for several reasons. The first reason is that labor is actually very beneficial for the baby. All of those contractions squeeze fluid out of the baby's lungs and avoid complications following birth and even later in life. That is why babies born vaginally can go straight home while babies born by C-section often are kept in the special care nursery for 24 hrs and in hospital for several days following. Secondly, a C-section is a surgery and as with all surgeries risks are inherent both during the surgery and following. The mother could have a reaction to the anaesthetic that is used. She could have post-op complications. She needs to heal, which means many weeks of no heavy lifting. Following a vaginal birth, she is able to go home almost immediately with very little monitoring. A C-section is necessary if the baby just is not going to make an appearance vaginally; if the baby is breech and the physician is not able to turn the baby or if the baby becomes distressed and is in danger of dying inutero. We must remember that quite a few babes and moms died in the old days during the birthing process so C-sections definitely have their place.

          • Thank you. I was playing possum, a little, for rhetorical purposes. I am aware of all that you have, so ably, related. My supposition, if it isn't already obvious, is that there is an incidence of C-section delivery in excess of the rates that necessity would dictate.

            I could be wrong.

  8. You would think a Dr or our Health System is advanced enough that you can trust that the surgery you go in for you get

  9. The biggest problem I have found with Ontario Doctors is COMMUNICATION!!! I was preped , IV'd and at the door of the OR the morning of my surgery when my surgeon (OBGYN) finally took time to read a note (that I had given the nurse upon addmission) from my Cardiologist that I needed a blood test done to confirm or rule out heart failure…. The surgery was cancelled. It turns out that my Cardio Dr, wasn't even aware that I was going in for surgery. Here I thought my "family" doctor, who had sent me to BOTH specialists, would have shared information. I could have been killed… I am 65 and totally aware, but I shudder to think of what a person may have to go through if they aren't on the ball. Henceforth, I will ask that a copy of any test be sent to ALL my caregivers and I will ask a helluva lot more questions. Doctors are VERY busy.