tag:theconversation.com,2011:/africa/topics/elective-surgery-19133/articlesElective surgery – The Conversation2022-01-20T04:06:41Ztag:theconversation.com,2011:article/1752332022-01-20T04:06:41Z2022-01-20T04:06:41ZOmicron is overwhelming Australia’s hospital system. 3 emergency measures aim to ease the burden<p>Public hospitals – never with much spare capacity – have been severely stressed by the latest COVID wave.</p>
<p>The current Omicron outbreak has loaded even heavier demands on hospital beds, both for those who need oxygen and for the severely ill in intensive care wards, as well as those who cannot be cared for at home or in an aged-care facility.</p>
<p>Shortages of beds and hospital equipment are matched by staffing problems as front-line workers <a href="https://www.theguardian.com/australia-news/2022/jan/03/covid-positive-nurses-are-working-in-nsw-hospitals-due-to-severe-staffing-shortages">catch COVID</a>, are contacts of cases, or are emotionally and physically <a href="https://7news.com.au/lifestyle/health-wellbeing/nsw-records-17-deaths-29504-covid-cases-c-5336468">exhausted</a>.</p>
<p>Staff are angry having to provide intensive care beds for people who choose not to be vaccinated and then get seriously ill. </p>
<p>Intensive care nurses in Sydney <a href="https://www.news.com.au/national/new-south-wales-icu-nurses-strike/video/3d88eba2d883e3b3462171a950bcd5b0">began strike action</a> outside Westmead Hospital on Wednesday to protest dangerous work conditions and low staffing levels.</p>
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<p>Many of our hospitals were not equipped to face an enemy like COVID.</p>
<p>Now, three emergency measures will help us muddle through the crisis, caused in part by the removal of public health controls just before the social festive season which commentators have referred to as “letting it rip”.</p>
<p>The combined effects of these short-term measures should enable us to cope with the pressures of increased numbers of patients requiring care.</p>
<p>But the sheer number of cases of Omicron, even if is milder than the Delta variant and assuming case numbers decline, will test these arrangements to the limit.</p>
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Read more:
<a href="https://theconversation.com/from-covid-control-to-chaos-what-now-for-australia-two-pathways-lie-before-us-174325">From COVID control to chaos – what now for Australia? Two pathways lie before us</a>
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<h2>1. Reinforcing the front line</h2>
<p>In Victoria, a “<a href="https://www.abc.net.au/news/2022-01-19/what-is-code-brown-emergency-in-victorian-hospitals/100765890">Code Brown</a>” has been implemented across the hospital system.</p>
<p>It means staff of major city and regional public hospitals may have their leave cancelled and be allocated to work where needs are greatest. Non-urgent care may be postponed.</p>
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<p>It’s designed to allow the hospitals to compensate for thousands more patients and several thousand fewer staff, off work because of COVID.</p>
<p>This is the first time the code has been used statewide.</p>
<p>It’s designed to respond to an emergency, such as a road accident, bushfire or other natural disaster.</p>
<h2>2. Recruiting the private sector</h2>
<p>The federal government has agreed <a href="https://www.abc.net.au/news/2022-01-18/private-hospitals-take-public-patients-omicron-covid-pressure/100764512">private hospitals should work with public hospitals</a> to care for COVID patients.</p>
<p>During the pandemic, most COVID patients have been treated in the public sector.</p>
<p>Health minister Greg Hunt said this week up to 57,000 nurses and thousands of support staff from private hospitals would be available to work in public hospitals.</p>
<p>This contingency plan was enacted in 2020 and held in reserve. Now it’s needed because of short staffing in the public sector because of the load and absenteeism of staff.</p>
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<p>The details – including wages – would be left to the states to determine. </p>
<p>This move should ease the pressure on public hospitals. But a nurse or other health worker from a private hospital working in a public hospital environment encounters yet more stress. It’s rather like moving between countries – language and customs vary, and in the strict, protocol-driven environment of the modern hospital, these differences can be dangerous.</p>
<p>The workers to be drawn from the private sector were not idle before the call-up. It is not clear who, if anyone, will do the work these people did previously in the private sector, which provides much elective surgery. Further delays and cancellations of surgery may result.</p>
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Read more:
<a href="https://theconversation.com/were-two-frontline-covid-doctors-heres-what-we-see-as-case-numbers-rise-167195">We're two frontline COVID doctors. Here's what we see as case numbers rise</a>
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<h2>3. Elective surgeries postponed</h2>
<p>Elective surgery – that is, non-urgent surgery – will be reduced in public hospitals across many parts of the country, if not completely cancelled. This includes hip and knee replacements and surgery for many problems other than emergencies.</p>
<p>This action has been taken at several stress points in the past two years.</p>
<p>For those people depending on Medicare and public hospitals for hip surgery, for example, this will mean further delays.</p>
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<p>There’s much to be learned from the experience in all sectors of the health enterprise – hospitals, general practice, public health, and health service management – from the successes and mistakes in how we’ve managed COVID. </p>
<p>When the COVID war is over, it will be time for forensic soul searching to enable us to build a modern and better health system.</p>
<p>We have done well, but not as well as we might.</p><img src="https://counter.theconversation.com/content/175233/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Leeder does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A public health expert explains emergency measures recently brought in to manage the impact of Omicron on our stressed health system.Stephen Leeder, Emeritus Professor, Menzies Centre for Health Policy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1462982020-09-17T08:06:40Z2020-09-17T08:06:40ZHow to clear Victoria’s backlog of elective surgeries after a 6-month slowdown? We need to rethink the system<figure><img src="https://images.theconversation.com/files/358534/original/file-20200917-16-ux134f.jpg?ixlib=rb-1.1.0&rect=25%2C8%2C5725%2C3819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>With the number of COVID-19 cases in Victoria continuing to trend downwards, Premier Daniel Andrews yesterday announced a <a href="https://www.premier.vic.gov.au/safely-reopening-elective-surgery-victorians">phased restart of elective procedures</a> in public and private hospitals.</p>
<p>Regional Victoria moves to return to 75% of usual elective surgery activity from today, and 85% from September 28. In metropolitan Melbourne, hospitals can move towards 75% from September 28, and 85% from October 26. A return to full capacity across the state is slated for November 23.</p>
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<p>But after two partial shutdowns totalling about six months, we’re left with a significant backlog of elective surgeries in Victoria. </p>
<p>To clear this backlog quickly and efficiently, the state government will need to make changes to the way it manages elective surgeries.</p>
<h2>Stopping and starting</h2>
<p>Elective procedures — particularly <a href="https://theconversation.com/what-elective-surgery-will-be-allowed-now-the-coronavirus-situation-has-improved-its-up-to-your-surgeon-or-hospital-137077">category 3 procedures</a>, which are deemed non-urgent but should be done within a year of listing — were one of the early casualties of COVID-19.</p>
<p>Hospitals have only been undertaking category 1 (urgent elective procedures that should be completed within 30 days of listing) and some category 2 procedures (semi-urgent, within 90 days).</p>
<p>The aim was to ensure there was adequate personal protective equipment for staff and beds would be available for an anticipated influx of patients with COVID-19. </p>
<p>There was a brief restart between the first and second waves of the pandemic, but the “care debt” of needed-but-deferred procedures mounted during both slowdowns. </p>
<p>The number of patients waiting for elective surgeries in Victoria increased almost 14% from December 2019 to June 2020, from <a href="https://vahi.vic.gov.au/elective-surgery/patients-waiting-treatment#:%7E:text=When%20a%20patient%20in%20Victoria,a%20hospital%2Dbased%20wait%20list.">49,341 to 56,039</a>. It’s almost certainly increased even more since then. New South Wales <a href="https://www.abc.net.au/news/2020-09-16/nsw-coronavirus-elective-surgery-waiting-list-blows-out/12665314">is facing a similar problem</a>. </p>
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Read more:
<a href="https://theconversation.com/getting-an-initial-specialists-appointment-is-the-hidden-waitlist-99507">Getting an initial specialists' appointment is the hidden waitlist</a>
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<h2>That’s just the tip of the iceberg</h2>
<p>Outpatient attendances have also slowed during the pandemic, meaning patients referred to public hospitals haven’t received the specialist assessments necessary to determine whether they need a procedure. </p>
<p>The number of <a href="https://vahi.vic.gov.au/specialist-clinics/new-appointments">new specialist appointments in public hospitals</a> in Victoria dropped by more than 15% between April-June 2019 and April-June 2020. That’s equivalent to more than 2,000 fewer appointments each week in 2020 compared to the same period in 2019.</p>
<p>So a further <a href="https://theconversation.com/getting-an-initial-specialists-appointment-is-the-hidden-waitlist-99507">hidden waiting list</a> — of unknown proportions — is looming behind the waiting list of patients assessed as needing a procedure.</p>
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<img alt="A man and a woman wearing masks sit in a waiting room." src="https://images.theconversation.com/files/358539/original/file-20200917-16-103mrda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358539/original/file-20200917-16-103mrda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358539/original/file-20200917-16-103mrda.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358539/original/file-20200917-16-103mrda.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358539/original/file-20200917-16-103mrda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358539/original/file-20200917-16-103mrda.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358539/original/file-20200917-16-103mrda.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">During the pandemic, fewer people are seeing specialists in public hospitals.</span>
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<p>Hospitals can ramp up their work temporarily to reduce the backlog. They could contract private hospitals, although private hospitals are busy clearing their own backlogs.</p>
<p>When the 75/85% caps are lifted, public hospitals could introduce overtime shifts, extending operating times in the evenings or on weekends. But even adding one extra day a week, it would take a whole year to clear 50 days’ worth of backlog.</p>
<h2>A better way</h2>
<p>Restarting the tired, failing approach to managing elective procedures — which left <a href="https://vahi.vic.gov.au/elective-surgery/patients-waiting-treatment">thousands waiting too long for care</a> even before the pandemic — will guarantee extended waits for those Victorians on the waiting list.</p>
<p>The Victorian government needs to make three immediate changes to address the problem.</p>
<p><strong>1. Centralise waiting lists</strong></p>
<p>Good management of lines — be it in supermarkets or for elective procedures — involves creating and managing a single queue. Multiple queues lead to <a href="https://www.cmaj.ca/content/192/21/E585">inequity and long waits</a>. </p>
<p>Hospital waiting lists in each specialty should be merged — potentially into three clusters in metropolitan Melbourne and three in regional Victoria. All orthopaedic patients in southeastern Melbourne, for example, should be on one list and offered a place at the first available location. </p>
<p>The government should provide extra funding for extra activity to help clear waiting lists — but that funding should prioritise hospitals that meet criteria of both good outcomes for patients and good efficiency. </p>
<p><strong>2. Review waiting lists</strong></p>
<p>Not everyone on a waiting list needs their elective procedure. We know <a href="https://qualitysafety.bmj.com/content/28/3/205">low-value care occurs in public hospitals</a>, and <a href="https://theconversation.com/hospitals-have-stopped-unnecessary-elective-surgeries-and-shouldnt-restart-them-after-the-pandemic-136259">we shouldn’t restart that</a>.</p>
<p>Non-surgical treatment should be considered where there’s good evidence it’s appropriate, such as in the case of <a href="https://theconversation.com/needless-treatments-spinal-fusion-surgery-for-lower-back-pain-is-costly-and-theres-little-evidence-itll-work-91829">spinal fusion surgery</a> and <a href="https://theconversation.com/surgery-isnt-always-the-best-option-and-the-decision-shouldnt-just-lie-with-the-doctor-64228">some orthopaedic procedures</a>. </p>
<p>Specialist clinical groups should review treatment pathways and admission criteria to ensure best contemporary practice is implemented as part of reopening elective procedures. This way, priority would go to patients most likely to benefit.</p>
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Read more:
<a href="https://theconversation.com/the-coronavirus-ban-on-elective-surgeries-might-show-us-many-people-can-avoid-going-under-the-knife-135325">The coronavirus ban on elective surgeries might show us many people can avoid going under the knife</a>
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<p><strong>3. Modernise the system</strong></p>
<p>Simply adding extra operating sessions won’t fix the extensive waiting list, let alone address the hidden backlog of people currently waiting for outpatient appointments.</p>
<p>Many patients having elective surgeries need to stay in hospital for several days, so the number of beds available can also limit capacity for admissions. </p>
<p>Hospitals should be funded to implement and evaluate changes in their approaches to treatment. For example, the current length of stay for elective hip replacements in Australia is <a href="https://grattan.edu.au/wp-content/uploads/2019/11/925-Saving-private-health-1.pdf">about four to five days</a>. But hospitals in Europe and the United States have been performing hip replacements on a same-day basis for selected patients for a decade, <a href="https://www.sciencedirect.com/science/article/pii/S088354031731032X">with comparable outcomes</a>.</p>
<p>Patients on waiting lists should also be offered programs to improve the likelihood of better outcomes from their surgery, for example “<a href="https://theconversation.com/prehabilitation-training-your-body-for-surgery-may-improve-recovery-reduce-complications-138991">prehabilitation</a>”, a strategy that uses exercise to improve patients’ functional capacity before surgery, and <a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0035/439784/smokingsurgery.pdf">quit smoking programs</a>. Patients in better health will stay in hospital for a shorter time.</p>
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<img alt="A man sits on his hospital bed looking out the window." src="https://images.theconversation.com/files/358540/original/file-20200917-24-h8lnjq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358540/original/file-20200917-24-h8lnjq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358540/original/file-20200917-24-h8lnjq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358540/original/file-20200917-24-h8lnjq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358540/original/file-20200917-24-h8lnjq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358540/original/file-20200917-24-h8lnjq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358540/original/file-20200917-24-h8lnjq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Some elective surgeries can probably be avoided.</span>
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<h2>Let’s capitalise on this opportunity</h2>
<p>The Victorian government’s announcement that elective procedures will restart is unquestionably welcome news for the tens of thousands of people waiting for a procedure. But it will be a missed opportunity if it doesn’t also involve rethinking the elective procedures system.</p>
<p>Fixing the backlog within a reasonable time will require major change to the way elective procedures are delivered in Victoria. This would benefit not only those currently waiting, but will have long-term effects after the pandemic has passed.</p>
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Read more:
<a href="https://theconversation.com/slow-and-steady-exit-from-lockdown-as-victorian-government-sets-sights-on-covid-normal-christmas-145558">'Slow and steady' exit from lockdown as Victorian government sets sights on 'COVID-normal' Christmas</a>
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<img src="https://counter.theconversation.com/content/146298/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities, as disclosed on its website.</span></em></p>Hospitals in regional Victoria can now begin ramping up their elective surgeries again, with metropolitan Melbourne soon to follow. But six months of partial shutdown has left a significant backlog.Stephen Duckett, Director, Health Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1377092020-05-06T04:18:54Z2020-05-06T04:18:54ZIVF is changing now clinics have reopened. Here’s what to expect during the coronavirus pandemic<figure><img src="https://images.theconversation.com/files/332929/original/file-20200506-49565-niy8ny.jpg?ixlib=rb-1.1.0&rect=2%2C5%2C995%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-having-eggs-implanted-part-ivf-155727896">Shutterstock</a></span></figcaption></figure><p>IVF clinics are now open after a temporary closure due to the coronavirus pandemic. But in some states clinics are not yet operating at full capacity. You will also see some changes to your care.</p>
<p>This is what we know so far.</p>
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Read more:
<a href="https://theconversation.com/good-news-on-elective-surgery-but-dire-warning-on-the-economy-136745">Good news on elective surgery, but dire warning on the economy</a>
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<h2>How events unfolded</h2>
<p>In late March, non-urgent elective surgeries, including IVF services, <a href="https://www.abc.net.au/news/2020-03-26/coronavirus-what-do-the-changes-to-elective-surgery-mean-for-you/12091804">were postponed</a>. The idea was to avoid the spread of coronavirus, help the health system prepare for the expected influx of coronavirus patients, and to preserve stocks of personal protective equipment (PPE) such as masks and gowns.</p>
<p>Many people who were getting ready to start IVF or who were in the middle of a treatment cycle were <a href="https://www.abc.net.au/news/2020-03-27/coronavirus-delays-causing-anguish-for-ivf-patients/12093450">distressed</a>.</p>
<p>Some weeks later, as the <a href="https://theconversation.com/how-to-flatten-the-curve-of-coronavirus-a-mathematician-explains-133514">famous curve</a> had flattened, Prime Minister Scott Morrison <a href="https://www.abc.net.au/news/2020-04-21/coroanvirus-national-cabinet-elective-surgery-ivf-to-resume/12168770">announced</a> IVF clinics could reopen:</p>
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<p>[…] subject of course to capacity and other constraints that may exist in each jurisdiction.</p>
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<h2>Different rules in different states</h2>
<p>Different states and territories implemented this announcement in different ways.
In some states, IVF clinics have resumed normal services. But in others, there are restrictions on the number of <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Assisted-reproductive-technology-IVF-and-ICSI">egg collection procedures</a> that can take place because they require hospital admission. </p>
<p>This means the number of women who can start treatment needing egg collection is limited and clinics might therefore prioritise women with the most urgent needs. </p>
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Read more:
<a href="https://theconversation.com/considering-using-ivf-to-have-a-baby-heres-what-you-need-to-know-108910">Considering using IVF to have a baby? Here's what you need to know</a>
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<p>However, women who want to have <a href="https://www.varta.org.au/information-support/assisted-reproductive-treatment/types-assisted-reproductive-treatment">frozen embryos transferred</a> should be able to have that done irrespective of where they live because it doesn’t involve a surgical procedure. It’s a simple procedure, similar to a pap smear, in which a thawed embryo is inserted into the woman’s uterus.</p>
<p>So existing and new patients should contact their clinic or treating specialist for advice on when their treatment can start. </p>
<h2>Here’s how your care might change</h2>
<p>Clinics are changing the way they operate in coming months to <a href="https://www.fertilitysociety.com.au/wp-content/uploads/20200422-RTAC-Technical-Bulletin-12_Reopening-of-IVF-Services-in-Australia-Post-COVID-19-Lockdown.pdf">manage the risk</a> of coronavirus transmission.</p>
<p>This is not only to protect patients and staff, but to limit the use of PPE, which might be needed elsewhere in the health system.</p>
<p>Clinics are minimising physical contact between patients and staff. So instead of meeting face-to-face, consultations with doctors, nurses, counsellors and accounting staff will be via phone or video conferencing wherever possible.</p>
<p>There will be fewer visits to the clinic and fewer people in the clinic (including in the waiting room) when patients attend. Appointments will be staggered so social distancing can be maintained.</p>
<p>To minimise the number of people in the clinic, some clinics won’t allow partners or other people to accompany women to appointments.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/332934/original/file-20200506-49565-1lqq5nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/332934/original/file-20200506-49565-1lqq5nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/332934/original/file-20200506-49565-1lqq5nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/332934/original/file-20200506-49565-1lqq5nf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/332934/original/file-20200506-49565-1lqq5nf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/332934/original/file-20200506-49565-1lqq5nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/332934/original/file-20200506-49565-1lqq5nf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/332934/original/file-20200506-49565-1lqq5nf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You will likely have your temperature checked before entering the clinic.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-holding-medical-device-infrared-forehead-1689449422">Shutterstock</a></span>
</figcaption>
</figure>
<p>If patients do need to attend the clinic, they will be asked about possible coronavirus symptoms (fever, cough, shortness of breath, sore throat), whether they’ve had close contact with someone who has tested positive for COVID-19, and have their temperature checked.</p>
<p>The federal government’s <a href="https://www.health.gov.au/sites/default/files/documents/2020/04/guidance-on-the-use-of-personal-protective-equipment-ppe-in-hospitals-during-the-covid-19-outbreak.pdf">advice</a> on PPE in hospitals is that “it’s business as usual” and “additional COVID-19 specific precautions are not required” for procedures on patients who are not suspected of having COVID-19.</p>
<h2>Is it safe to have IVF now?</h2>
<p>People might worry about the risks of COVID-19 and whether it’s safe to embark on pregnancy right now. </p>
<p>Because COVID-19 has only been around for a short time, it’s hard to know how it might affect people’s fertility, and the health of pregnant women and their babies.</p>
<p>However, based on the <a href="https://www.sciencedirect.com/science/article/pii/S001502822030385X">latest evidence</a>:</p>
<ul>
<li><p>fever associated with COVID-19 can affect sperm quality for about three months, so may temporarily reduce fertility</p></li>
<li><p>pregnant women are not more likely to get infected by the coronavirus than other women, nor are they at higher risk for severe illness</p></li>
<li><p>women who become seriously ill with COVID-19 in late pregnancy are more likely than other pregnant women to deliver their babies prematurely</p></li>
<li><p>after birth, transmission of COVID-19 from mother to child has been reported, but there has been no indication these infants have any significant problems.</p></li>
</ul>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S2589933320300483?via%3Dihub">recent study</a> of 43 pregnant women in the USA who had been admitted to hospital and tested positive for COVID-19 found nearly nine out of 10 had mild disease.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-while-pregnant-or-giving-birth-heres-what-you-need-to-know-133619">Coronavirus while pregnant or giving birth: here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>Ready to start IVF?</h2>
<p>For people who have been anxiously waiting to start IVF the good news is clinics have now reopened, albeit with reduced capacity in some states.</p>
<p>The bad news is that for some, the financial consequences of COVID-19 might mean they cannot afford IVF.</p>
<p>If you decide to postpone IVF for financial or other reasons, getting into shape will <a href="https://www.yourfertility.org.au/">increase your chance</a> of having a healthy baby when the time is right. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-drop-my-private-health-insurance-during-the-pandemic-137156">Should I drop my private health insurance during the pandemic?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/137709/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karin Hammarberg is affiliated with the Victorian Assisted Reproductive Treatment Authority</span></em></p><p class="fine-print"><em><span>Prof Luk Rombauts is a minority shareholder of Monash IVF Group and the President of the Fertility Society of Australia.</span></em></p>Expect fewer visits to the clinic, fewer people in the waiting room at once, and temperature checks.Karin Hammarberg, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, Monash UniversityLuk Rombauts, Adjunct clinical professor, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1371562020-04-29T06:35:56Z2020-04-29T06:35:56ZShould I drop my private health insurance during the pandemic?<figure><img src="https://images.theconversation.com/files/331229/original/file-20200429-110734-1gx318o.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/busy-nurses-station-modern-hospital-361328798">Shutterstock</a></span></figcaption></figure><p>Many Australians, especially those experiencing financial hardship due to COVID-19, are asking whether they can afford to keep their private health insurance.</p>
<p>Others don’t know if they should drop or downgrade their cover, especially if they cannot or don’t want to access services they’ve paid for.</p>
<p>Now consumer group Choice <a href="https://us4.campaign-archive.com/?u=270103a13e38b9f6643b82a8e&id=d9e5af4fa1">is recommending</a> <a href="https://www.abc.net.au/news/2020-04-24/calls-for-private-insurance-rebates-amid-coronavirus-pandemic/12178828">people think about</a> dropping extras cover, dropping or downgrading hospital cover and asking their insurance company for hardship considerations, which include waiving premiums or suspending their policy.</p>
<p>What options do you have? And what are the implications of dropping or downgrading your cover?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-you-really-need-private-health-insurance-heres-what-you-need-to-know-before-deciding-93661">Do you really need private health insurance? Here's what you need to know before deciding</a>
</strong>
</em>
</p>
<hr>
<h2>What services can I use?</h2>
<p>Our <a href="https://theconversation.com/do-you-really-need-private-health-insurance-heres-what-you-need-to-know-before-deciding-93661">research</a> shows people take out private health insurance because of shorter waiting times for elective surgery, choice of doctor or hospital, access to a private hospital room, and extras like dental and physiotherapy services.</p>
<p>Although some elective surgeries are due to <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/elective-surgery-restrictions-eased">resume this week</a>, it’s unclear how long it will take hospitals to clear the backlog, which surgeries will be performed and where. This raises questions about whether consumers will be able to access the benefits they value in having private health insurance. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-elective-surgery-will-be-allowed-now-the-coronavirus-situation-has-improved-its-up-to-your-surgeon-or-hospital-137077">What elective surgery will be allowed now the coronavirus situation has improved? It's up to your surgeon or hospital</a>
</strong>
</em>
</p>
<hr>
<p>While a key reason for taking out private health insurance is to avoid waiting times, people may now have to <a href="https://theconversation.com/what-elective-surgery-will-be-allowed-now-the-coronavirus-situation-has-improved-its-up-to-your-surgeon-or-hospital-137077">wait</a> while hospitals and health care providers resume a staged approach to resuming elective surgery and general treatments impacted by the pandemic.</p>
<p>People may also be worried about whether they will receive the care they need if they have COVID-19. However, they should be assured that emergency treatment will be provided through the public system. Many private health insurance companies will also now <a href="https://www.moneymag.com.au/coronavirus-private-health-insurance">cover COVID-19 related treatments</a>. </p>
<h2>How are private insurers responding?</h2>
<p>Modelling by the <a href="https://www.tai.org.au/sites/default/files/P910%20Private%20eyes%E2%80%A6%2C%20hips%2C%20etc%20%5BWEB%5D.pdf">Australia Institute</a> shows private health insurers could make considerable savings due to a reduction in claims paid to, or on behalf of, consumers during the pandemic. </p>
<p>This is because services, such as elective surgery, and general treatments, such as dental services, are not available or are limited. And it recommends some of these savings should be passed on to policy holders.</p>
<p>Private health insurance companies have <a href="https://www.privatehealthcareaustralia.org.au/health-funds-postpone-1-april-premium-increase/">assured</a> consumers that any increase in premiums will be delayed by at least six months.</p>
<p>They have also said that some funds resulting from the cancellation of elective surgery or allied health services will be <a href="https://www.privatehealthcareaustralia.org.au/health-funds-committed-to-providing-financial-relief-for-members-impacted-by-covid-19/">returned to customers</a>. It isn’t clear, though, how this will be done and over what period. </p>
<h2>What options do I have?</h2>
<p>It’s not surprising if you’re confused about whether to keep, drop or downgrade your private health insurance.</p>
<p>Our research consistently shows consumers find changing private health cover <a href="https://theconversation.com/confused-about-your-private-health-insurance-coverage-youre-not-alone-49493">confusing</a>. Increasing costs of premiums, value for money and difficulties understanding policies are <a href="https://theconversation.com/explainer-why-do-australians-have-private-health-insurance-38788">common concerns</a>. People aren’t certain what they need cover for, what is a reasonable price to pay, and how much difference there is between the public and private systems.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/confused-about-your-private-health-insurance-coverage-youre-not-alone-49493">Confused about your private health insurance coverage? You're not alone</a>
</strong>
</em>
</p>
<hr>
<p>If you are thinking about downgrading your hospital cover or stopping extras cover, think about what services you may need in the future. </p>
<p>Remember that if you downgrade your hospital cover to a lower level of cover some services may be excluded (for instance, pregnancy). If you decide to increase your level of hospital cover in the future you may also need to re-serve waiting periods for those services excluded at the lower level of cover. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lower levels of cover may exclude some services, such as pregnancy care, which may be relevant in the future.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-sitting-on-bench-background-150533705">Shutterstock</a></span>
</figcaption>
</figure>
<p>If you drop your hospital cover and take it up again in the future, you may pay more due to the <a href="https://www.privatehealth.gov.au/health_insurance/surcharges_incentives/lifetime_health_cover.htm">Lifetime health cover</a> loading (if you do not take private health insurance up again <a href="https://www.privatehealth.gov.au/health_insurance/surcharges_incentives/lifetime_health_cover.htm">within 1,094 days</a> of dropping your cover).</p>
<p>Choice is also recommending people <a href="https://us4.campaign-archive.com/?u=270103a13e38b9f6643b82a8e&id=d9e5af4fa1">drop</a> their extras cover. But your decision about this will depend on the types of services you typically use. </p>
<p>If you decide to drop your extras cover, you may also be required to <a href="https://www.ombudsman.gov.au/__data/assets/pdf_file/0017/35612/Waiting-periods-DL-Fyler-Web.pdf">re-serve waiting periods</a> if you take up extras again in the future. </p>
<p>This means you may need to wait two months for general dental services or physiotherapy, but 12 months for major dental procedures. However these waiting periods vary according to procedure and insurer. So to find out what waiting periods apply, ask your health fund. </p>
<p>If you are experiencing financial hardship you may be able to ask your fund to temporarily waive your premiums or suspend your policy. However, you won’t be covered while your health insurance is suspended.</p>
<h2>What happens after the coronavirus?</h2>
<p>The pandemic highlights issues with Australia’s health-care system, and how private health insurance operates and is funded. </p>
<p>There has been much critique of government policy encouraging Australians to take out private health insurance, and in particular the <a href="https://theconversation.com/private-health-insurance-rebates-dont-serve-their-purpose-lets-talk-about-scrapping-them-91061">subsidising of premiums</a> through the private health insurance rebate.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/elective-surgerys-due-to-restart-next-week-so-nows-the-time-to-fix-waiting-lists-once-and-for-all-136835">Elective surgery's due to restart next week so now's the time to fix waiting lists once and for all</a>
</strong>
</em>
</p>
<hr>
<p>At a time when more consumers are experiencing financial hardship they will question the value of their private health insurance even more than before. </p>
<p>There may be <a href="https://theconversation.com/elective-surgerys-due-to-restart-next-week-so-nows-the-time-to-fix-waiting-lists-once-and-for-all-136835">other ways</a> of providing health-care, including fixing waiting lists, that meet the needs of all Australians, while retaining the best aspects of both public and private care.</p>
<hr>
<p><em>As decisions about whether to change your private health insurance depend on your personal circumstances, please discuss your options and their implications with your health fund or read the fine print on policy documents.</em></p>
<p><em>For independent advice and consumer resources, see the government’s private health insurance <a href="https://www.privatehealth.gov.au/">website</a>, health department <a href="https://www.health.gov.au/resources/collections/private-health-insurance-reforms-consumer-resources">website</a> or consumer organisation websites such as <a href="https://chf.org.au/blog/gold-silver-bronze-making-health-insurance-easier-navigate">Consumers Health Forum of Australia</a> or <a href="https://www.choice.com.au/money/insurance/health">Choice</a>.</em></p><img src="https://counter.theconversation.com/content/137156/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophie Lewis receives funding from the Australian Research Council and the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Karen Willis receives funding from The Australian Research Council (ARC).</span></em></p>Drop, suspend, downgrade or keep? Many people are feeling the pinch and wondering if private heath insurance is worth keeping during the coronavirus pandemic. Here’s what to consider.Sophie Lewis, Senior Research Fellow, Centre for Social Research in Health, UNSW SydneyKaren Willis, Professor, Allied Health Research, Melbourne Health, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1370772020-04-23T05:14:32Z2020-04-23T05:14:32ZWhat elective surgery will be allowed now the coronavirus situation has improved? It’s up to your surgeon or hospital<figure><img src="https://images.theconversation.com/files/329965/original/file-20200423-47815-4thcy1.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3828%2C2155&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Australian Prime Minister Scott Morrison has announced <em>some</em> elective surgery can start again in private hospitals, as it becomes clear the health system will cope with the additional coronavirus demand.</p>
<p>He <a href="https://www.pm.gov.au/media/press-conference-australian-parliament-house-act-16">said</a> this week “all Category 2 or equivalent procedures in the private sector, and selected Category 3 and other procedures, which includes all IVF” can restart.</p>
<p>What’s this mean for you? It all depends on which category you are in – and what your surgeon has decided about how urgently your surgery is needed. </p>
<p>It also depends on whether you are a patient in a private hospital or public hospital. If it’s the latter, you can expect to wait a while until the hospital can tell you exactly when your surgery will happen.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/good-news-on-elective-surgery-but-dire-warning-on-the-economy-136745">Good news on elective surgery, but dire warning on the economy</a>
</strong>
</em>
</p>
<hr>
<h2>Category 1, Category 2, Category 3: what’s the difference?</h2>
<p>Private hospitals have not had elective surgery waiting lists in the past and so have not categorised patients for elective surgery. So it’s no surprise this announcement has created enormous confusion. </p>
<p>States have not yet announced their plans for restarting elective surgery.</p>
<p>Elective procedures are categorised into <a href="https://meteor.aihw.gov.au/content/index.phtml/itemId/598034">three categories based on urgency</a>: </p>
<ul>
<li>Category 1, the most urgent, is where patients should be seen within 30 days</li>
<li>Category 2 patients should be seen within 90 days</li>
<li>Category 3 patients should be seen within 365 days. </li>
</ul>
<p>Categorisation is done by the surgeon and takes into account the specific circumstances of the patient. For example, they would consider the extent of the pain and mobility loss, and the impact on the work or education if the surgery was delayed.</p>
<h2>Different surgeons can assign patients different categories</h2>
<p>Unfortunately, different surgeons seeing the same patient may make different assessments of what category they should be in. This policy issue <a href="https://theconversation.com/elective-surgerys-due-to-restart-next-week-so-nows-the-time-to-fix-waiting-lists-once-and-for-all-136835">needs to be addressed</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/elective-surgerys-due-to-restart-next-week-so-nows-the-time-to-fix-waiting-lists-once-and-for-all-136835">Elective surgery's due to restart next week so now's the time to fix waiting lists once and for all</a>
</strong>
</em>
</p>
<hr>
<p>There is no fixed rule about whether a particular procedure is always in a specific category. </p>
<p>However, generally cardiac surgery, such as a heart bypass, will be classified as Category 1. More than half of all patients awaiting this procedure are treated within three weeks.</p>
<p>A patient waiting for a hip replacement, on the other hand, will be typically categorised as Category 2 or 3. In fact, <a href="https://www.aihw.gov.au/reports-data/myhospitals/sectors/elective-surgery#more-data">half</a> the patients waiting for that procedure had to wait up to four months.</p>
<p>Waiting times for public hospital treatment is longer in some states and others. Data for elective surgery waiting times it is <a href="https://www.aihw.gov.au/reports-data/myhospitals/sectors/elective-surgery#more-data">published by the Australian Institute of Health and Welfare</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329966/original/file-20200423-47820-1lw8gz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329966/original/file-20200423-47820-1lw8gz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329966/original/file-20200423-47820-1lw8gz6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329966/original/file-20200423-47820-1lw8gz6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329966/original/file-20200423-47820-1lw8gz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329966/original/file-20200423-47820-1lw8gz6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329966/original/file-20200423-47820-1lw8gz6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Categorisation is done by the surgeon and takes into account the specific circumstances of the patient.</span>
<span class="attribution"><span class="source">www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>How do I know what category I’m in?</h2>
<p>If you are scheduled for an operation in a private hospital, either the hospital or the surgeon will contact you. </p>
<p>They will let you know if your surgery is now going ahead, and discuss with you appropriate timing. Elective surgery will commence over the next week, so private hospital patients should hear from the hospital surgery within the next fortnight or so.</p>
<p>Because states haven’t yet revealed their strategies for restarting elective surgery, public hospital patients should not expect to hear from the public hospital until those announcements have been made.</p>
<p><em>This article is supported by the <a href="https://theconversation.com/au/partners/judith-neilson-institute">Judith Neilson Institute for Journalism and Ideas</a>.</em></p><img src="https://counter.theconversation.com/content/137077/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities, as disclosed on its website.</span></em></p>If you’re scheduled for surgery in a private hospital, the hospital or surgeon will contact you. Public hospital patients shouldn’t expect to hear from the hospital until we hear more from the states.Stephen Duckett, Director, Health Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1368352020-04-22T03:55:49Z2020-04-22T03:55:49ZElective surgery’s due to restart next week so now’s the time to fix waiting lists once and for all<figure><img src="https://images.theconversation.com/files/329614/original/file-20200422-82650-k0jniv.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C4969%2C3325&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Monkey Business Images/Shutterstock</span></span></figcaption></figure><p>The near-total shutdown of elective surgery across Australia <a href="https://www.abc.net.au/news/2020-04-21/coroanvirus-national-cabinet-elective-surgery-ivf-to-resume/12168770">will end soon</a>, following National Cabinet consideration on Tuesday.</p>
<p>The shutdown was imposed to ensure there would be enough personal protective equipment (PPE) for doctors and nurses to manage a projected tsunami of COVID-19 patients in our hospitals.</p>
<p>But now there is a big backlog of Australians waiting for elective procedures.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/good-news-on-elective-surgery-but-dire-warning-on-the-economy-136745">Good news on elective surgery, but dire warning on the economy</a>
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<p>Elective surgery waiting times are the bane of every state health minister’s life. Better ways to manage such procedures could be a major benefit from the shutdown and restart.</p>
<p>But we have to act quickly if we are to change how we manage these wait lists, as federal Health Minister Greg Hunt <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/elective-surgery-restrictions-eased">wants a staged reintroduction</a> to begin on April 27. </p>
<h2>Rethink priorities</h2>
<p>Currently, elective surgery is <a href="https://meteor.aihw.gov.au/content/index.phtml/itemId/598034">classified</a> as urgent (category 1), semi-urgent (category 2) and non-urgent (category 3). But different hospitals and different surgeons actually classify patients in different ways. </p>
<p>What’s worse is that some procedures are undoubtedly unnecessary, such as spinal fusion or removing healthy ovaries during a hysterectomy, and would provide no value for the patient, as <a href="https://theconversation.com/hospitals-have-stopped-unnecessary-elective-surgeries-and-shouldnt-restart-them-after-the-pandemic-136259">Adam Elshaug and I have argued before</a>.</p>
<p>Of course, not all of the backlog is low-value procedures. As states consider how to recommence elective surgery, they should seize this opportunity to introduce new systems, especially in metropolitan areas.</p>
<p>A properly managed elective procedures system should have three key elements:</p>
<ul>
<li><p>there should be a consistent process for assessing a patient’s need for the procedure, and ranking that patient’s priority against others</p></li>
<li><p>the team performing the procedure, and caring for the patient afterwards, should be highly experienced in the procedure</p></li>
<li><p>the procedure should be performed at an efficient hospital or other facility, so the cost to the health system is as low as possible.</p></li>
</ul>
<p>Unfortunately, Australia sometimes fails on all three measures.</p>
<h2>Stop the inconsistencies</h2>
<p>There is no consistent assessment process across hospitals. Even different surgeons in the same hospital seeing the same patient sometimes make different recommendations about the need for a procedure.</p>
<p>This means a patient lucky enough to be seen at hospital A may be assigned to category 2, but the same patient seen at hospital B might be assigned to category 3 and so have to wait longer.</p>
<p>Patient characteristics, such as <a href="https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-016-0302-3" title="Inequity in waiting for cataract surgery - an analysis of data from the Swedish National Cataract Register">gender</a> or <a href="https://link.springer.com/article/10.1186/1472-6963-12-268" title="Socioeconomic differences in waiting times for elective surgery: a population-based retrospective study">level of education</a>, also seem to inappropriately affect categorisation decisions.</p>
<p>High-volume hospitals and other facilities generally have <a href="https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-016-0376-4" title="Relationship between surgeon volume and outcomes: a systematic review of systematic reviews">better outcomes for a given procedure than low-volume centres</a>. And they are more efficient. </p>
<p>Yet most states ignore these facts. They have done little to <a href="https://www.dhhs.vic.gov.au/publications/targeting-zero-review-hospital-safety-and-quality-assurance-victoria">rationalise services</a> for the benefit of both the patient and the taxpayer.</p>
<h2>Time for change</h2>
<p>The large backlog of demand creates the opportunity for a new way of doing things. States should develop agreed assessment processes for high-volume procedures, such as knee and hip replacements and cataract operations, and reassess all patients on hospital waiting lists. </p>
<p>Reassessment could be done remotely using telehealth. Specialists in each area should be invited to develop evidence-based criteria for setting priorities. Where appropriate, patients should be diverted to treatment options other than surgery. </p>
<p>Private health insurers should be empowered to participate in <a href="https://grattan.edu.au/wp-content/uploads/2019/11/925-Saving-private-health-1.pdf">funding diversion options</a> so patients are able to have their rehabilitation at home rather than in a hospital bed.</p>
<p>A new, coordinated, single waiting list priority system in each state would enable all patients to know where they stand. A patient on the top of the list would be offered the first available place, regardless of whether it was closest to their home.</p>
<p>They could refuse the offer, without losing their place in the queue, if they wanted to wait for a closer location.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/329624/original/file-20200422-82645-jzlull.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/329624/original/file-20200422-82645-jzlull.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329624/original/file-20200422-82645-jzlull.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329624/original/file-20200422-82645-jzlull.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329624/original/file-20200422-82645-jzlull.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329624/original/file-20200422-82645-jzlull.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329624/original/file-20200422-82645-jzlull.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329624/original/file-20200422-82645-jzlull.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The health minister says it’s up to hospitals to decide which patients get to undergo elective surgery.</span>
<span class="attribution"><span class="source">Roman Zaiets/Shutterstock</span></span>
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</figure>
<p>The single waiting list should include both regional and metropolitan patients, to ensure as much as possible that city patients do not get faster treatment than people in regional and remote area. </p>
<p>Patients with private health insurance can <a href="https://www.healthdirect.gov.au/understanding-the-public-and-private-hospital-systems">opt to be treated as a private patient </a>in a public hospital. So the waiting list should include public and private patients, to prevent private patients gaining faster admission to public hospitals.</p>
<p>The system should be further centralised in metropolitan areas. The full range of elective procedures should not be re-established in every hospital. Some surgeons would need to be offered new appointments if elective surgery in their specialty was no longer being performed at the hospital where they previously had their main appointment.</p>
<h2>Private hospitals can help</h2>
<p>The private hospital system has taken a battering during the pandemic. <a href="https://www.theguardian.com/world/2020/mar/28/australias-private-hospitals-face-closure-after-coronavirus-causes-elective-surgery-ban">Private hospitals have effectively been closed</a>, and their viability may be under pressure.</p>
<p>States should consider signing contracts with private hospitals, at or below the <a href="https://www.ihpa.gov.au/what-we-do/national-efficient-price-determination">public hospital efficient price</a>, for elective procedures to be performed in these hospitals to help clear the elective surgery backlog.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/needless-treatments-spinal-fusion-surgery-for-lower-back-pain-is-costly-and-theres-little-evidence-itll-work-91829">Needless treatments: spinal fusion surgery for lower back pain is costly and there's little evidence it'll work</a>
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<p>As part of the new service model, states should bolster their <a href="https://www.mja.com.au/journal/2012/197/9/meta-analysis-hospital-home">hospital-in-the-home systems</a>. For many patients, rehabilitation at home or as an outpatient can produce <a href="https://www.mja.com.au/journal/2018/209/5/predictors-inpatient-rehabilitation-after-total-knee-replacement-analysis">better outcomes than in-hospital rehabilitation</a>.</p>
<p>The pandemic is not over yet and policymakers are right to be turning their minds to the transition back to something approaching business as usual. But the new, post-pandemic normal should be nothing like the old.</p>
<p>Physical distancing seems to be beating the virus, but the second victim might be health reform. Not wasting the crisis is the cliché on everyone’s lips. Australia has the chance to improve our elective surgery system. For the sake of taxpayers and patients, we should grasp it.</p><img src="https://counter.theconversation.com/content/136835/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities, as disclosed on its website.</span></em></p>The COVID-19 pandemic gives us a chance to improve our elective surgery system when it restarts.Stephen Duckett, Director, Health Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1367452020-04-21T06:46:18Z2020-04-21T06:46:18ZGood news on elective surgery, but dire warning on the economy<p>Restrictions are to be eased on elective surgery, enabling a “gradual restart” to procedures next week.</p>
<p>But as national cabinet took early baby steps towards restoring normality, Reserve Bank Governor Phil Lowe warned the first half of this year would likely see the biggest contraction in Australia’s national output and income since the 1930s depression.</p>
<p>After Tuesday’s national cabinet meeting, Scott Morrison announced that from Monday, category 2 and some important category 3 procedures can restart in public and private hospitals. These were earlier suspended amid uncertainty about how hard COVID-19 would hit the hospital system.</p>
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Read more:
<a href="https://theconversation.com/private-hospitals-get-grace-period-before-freeze-on-non-urgent-elective-surgery-134684">Private hospitals get grace period before freeze on non-urgent elective surgery</a>
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<p>Category 2 covers cases needing treatment within 90 days; category 3 are ones that require treatment in the next year. </p>
<p>The easing will cover:</p>
<ul>
<li><p>IVF</p></li>
<li><p>screening programs (cancer and other diseases)</p></li>
<li><p>post cancer reconstruction procedures (such as breast reconstruction)</p></li>
<li><p>procedures for children under 18 years of age</p></li>
<li><p>joint replacements (incl knees, hips, shoulders)</p></li>
<li><p>cataracts and eye procedures</p></li>
<li><p>endoscopy and colonoscopy procedures.</p></li>
</ul>
<p>More dentistry services will also be available.</p>
<p>The elective surgery easing has been facilitated by the extra availability of protective equipment; also, the low number of COVID-19 cases has meant the pandemic has not placed as much demand on beds as had been feared.</p>
<p>It is estimated the announced easing will lead to reopening about 25% of the elective surgery activity that had been closed in private and public hospitals.</p>
<p>Morrison said the situation would be reviewed on May 11 to decide whether all surgeries and procedures could recommence more broadly.</p>
<p>Clinical decisions will determine the priority given to cases.</p>
<p>The Prime Minister said the easing “is an important decision because it marks another step on the way back. There is a road back”.</p>
<p>On aged care, national cabinet was concerned some nursing homes are being too extreme, with full lockdowns that do not allow residents to have any visitors.</p>
<p>People in nursing homes are particularly vulnerable to the coronavirus and there have been outbreaks and deaths in the sector.</p>
<p>But “there is great concern that the isolation of elderly people in residential care facilities, where they have been prevented from having any visits … is not good for their well-being, is not good for their health,” Morrison said.</p>
<p>The national cabinet gave a “strong reminder” that its earlier decision was “not to shut people off or to lock them away in their rooms.”</p>
<p>This decision was to allow a maximum of two visitors at one time a day, with the visit taking place in the resident’s room. Apart from that, residents should be able to move around the facility.</p>
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<strong>
Read more:
<a href="https://theconversation.com/hospitals-have-stopped-unnecessary-elective-surgeries-and-shouldnt-restart-them-after-the-pandemic-136259">Hospitals have stopped unnecessary elective surgeries – and shouldn't restart them after the pandemic</a>
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<p>Further restrictions would apply where there was an outbreak in a facility, or in the area.</p>
<p>On the economic front, in an indication of the devastating job losses that have already occurred, Morrison said since March 16, 517,000 JobSeeker claims had been processed. JobSeeker used to known as Newstart.</p>
<p>“By the end of this week we will have processed as many JobSeeker claims in six weeks [as] we would normally do in the entirety of the year,” he said.</p>
<p>In a speech at the Reserve Bank Lowe said it was difficult to be precise about the size of the contraction underway.</p>
<p>But on the bank’s current thinking:</p>
<ul>
<li><p>national output was likely to fall by about 10% over the first half of 2020, with most of the decline in the June quarter</p></li>
<li><p>total hours worked were likely to decline by about 20% in the first half of the year</p></li>
<li><p>unemployment was likely to be about 10% by June, “although I am hopeful that it might be lower than this if businesses are able to retain their employees on lower hours.”</p></li>
</ul>
<p>Lowe predicted inflation would turn negative in the June quarter, and it was likely prices would turn out to have fallen over the entirety of this financial year, the first time that had happened in 60 years</p>
<p>Lowe expressed confidence the economy would “bounce back”, but stressed the recovery’s timing and pace would depend on “how long we need to restrict our economic activities, which in turn depends on how effectively we contain the virus”. </p>
<p>“One plausible scenario is that the various restrictions begin to be progressively lessened as we get closer to the middle of the year, and are mostly removed by late in the year, except perhaps the restrictions on international travel.</p>
<p>"Under this scenario we could expect the economy to begin its bounce-back in the September quarter and for that bounce-back to strengthen from there.</p>
<p>"If this is how things play out, the economy could be expected to grow very strongly next year, with GDP growth of perhaps 6–7%, after a fall of around 6% this year,” Lowe said.</p>
<p>He said unemployment was likely to remain above 6% over the next couple of years.</p>
<p>“Whatever the timing of the recovery, when it does come, we should not be expecting that we will return quickly to business as usual.”</p>
<p>“It is highly probable that the severe shocks we are now experiencing will change the mindsets of some people and businesses. Even after the restrictions are lifted, it is likely that some of the precautionary behaviour will persist.</p>
<p>"And in the months ahead, we are likely to lose some businesses, despite best efforts, and some of these businesses will not reopen. There will also be a higher level of debt and some households might revaluate the risks of having highly leveraged balance sheets.</p>
<p>"It is also probable that there will be structural changes in the economy. We are all learning to work, shop and travel differently. Some of these changes will probably stay with us, requiring a rethinking of business models. So the crisis will have reverberations through our economy for some time to come.”</p><img src="https://counter.theconversation.com/content/136745/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Restrictions are to be eased on elective surgery, enabling a “gradual restart” to procedures next week.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1353252020-04-08T04:35:11Z2020-04-08T04:35:11ZThe coronavirus ban on elective surgeries might show us many people can avoid going under the knife<figure><img src="https://images.theconversation.com/files/326002/original/file-20200407-36391-1qxwlzw.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C5066%2C2866&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As part of the government’s response to the COVID-19 pandemic, all elective surgeries <a href="https://www.abc.net.au/news/2020-03-26/coronavirus-what-do-the-changes-to-elective-surgery-mean-for-you/12091804">across Australia</a> have been temporarily cancelled. </p>
<p>Elective surgery is non-urgent surgery people choose (elect) to have: things like cataract surgery, joint replacement, tonsillectomy, hernia repair and cosmetic surgery. </p>
<p>There are <a href="https://www.aihw.gov.au/reports/hospitals/hospitals-at-a-glance-2017-18/contents/surgery-in-australias-hospitals">more than two million</a> hospital admissions involving elective surgery in Australia each year; two-thirds in private hospitals and one-third in public hospitals. Accordingly, elective surgeries make up a huge part of overall health expenditure. </p>
<p>So when they stop all of a sudden, it’s a big deal.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/private-hospitals-get-grace-period-before-freeze-on-non-urgent-elective-surgery-134684">Private hospitals get grace period before freeze on non-urgent elective surgery</a>
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<h2>What does this mean for patients?</h2>
<p>People who were booked in for surgery will simply have to wait. Because their surgery was deemed non-urgent, this might not be too bad if the shutdown lasts for six weeks. But what if it lasts for six months?</p>
<p>Private patients will face delays that are probably less than the usual waiting lists in public hospitals (up to <a href="https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2012_011.pdf">12 months</a> for elective surgery), but public patients may have to wait even longer. </p>
<p>This large scale halt on elective surgeries is unprecedented, so we don’t have any data on what kinds of consequences we might expect. But <a href="https://www.ncbi.nlm.nih.gov/pubmed/26013773">research suggests</a> people who wait for surgery can deteriorate proportional to the length of time they wait. So a few risks come to mind.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/326316/original/file-20200408-108526-1cub5u0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326316/original/file-20200408-108526-1cub5u0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326316/original/file-20200408-108526-1cub5u0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326316/original/file-20200408-108526-1cub5u0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326316/original/file-20200408-108526-1cub5u0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326316/original/file-20200408-108526-1cub5u0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326316/original/file-20200408-108526-1cub5u0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People waiting for elective surgeries may have to cope for longer with restricted mobility and pain.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Patients may need to rely on strong pain medications for a longer time, and could be more likely to become dependent on these.</p>
<p>Older people in particular may have to cope for longer with restricted mobility while waiting for a hip replacement. Or they may be at increased risk of falls due to poor eyesight while waiting to have their cataracts fixed.</p>
<p>So while this move has been designed to reduce pressure on our hospitals, we may end up with more acute presentations to emergency departments.</p>
<h2>It’s not all bad news</h2>
<p>Some people, however, might find their condition improves. While cataracts won’t clear up on their own, many elective procedures are done for conditions that can improve without surgery. </p>
<p>My area of specialty is orthopaedics, the branch of surgery concerned with conditions involving the musculoskeletal system. </p>
<p>In all <a href="https://academic.oup.com/painmedicine/article/18/4/736/2924731">recent</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/24369076">studies</a> where researchers have tested common <a href="https://bjsm.bmj.com/content/51/24/1759">elective orthopaedic surgical procedures</a> <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30778-5/fulltext">against a placebo</a> (just an incision, for example), the improvement in symptoms has been <a href="https://www.bmj.com/content/362/bmj.k2860">quite good</a>, regardless of whether or not participants had the surgery or the placebo.</p>
<p>My colleagues and I currently have a review <a href="https://journals.lww.com/pain/pages/default.aspx">in press</a> looking at studies where patients have been randomised to surgery or no surgery for chronic musculoskeletal pain. These procedures include spine fusions and decompressions for back and leg pain, carpal tunnel decompression, arthroscopic surgery for shoulder and knee pain, and joint replacement surgery.</p>
<p>We found only 14% of the studies showed surgery was clearly better than not doing the surgery. In most studies it was a toss-up, or the patients who had surgery fared worse.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/surgery-isnt-always-the-best-option-and-the-decision-shouldnt-just-lie-with-the-doctor-64228">Surgery isn't always the best option, and the decision shouldn't just lie with the doctor</a>
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<p>Even elective procedures we know to be effective, such as knee replacements, have alternatives. One <a href="https://www.oarsijournal.com/article/S1063-4584(18)31221-4/fulltext">study</a> compared patients who underwent knee replacement surgery to patients who didn’t, where both groups were given a 12-week physiotherapy program.</p>
<p>While the surgery group demonstrated better results, those treated without surgery also improved. And two-thirds had avoided surgery up to two years later.</p>
<p>Maximising patient education about the risks and benefits of treatment options using specially designed “decision aids” is another technique that has <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001431.pub5/full">reduced the uptake</a> of elective surgery.</p>
<p>In New South Wales, education and non-surgical treatment for people on waiting lists for knee replacements has resulted in <a href="https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0008/570869/OACCP-evaluation-feb-2015.pdf">more than 10% of patients</a> coming off the waiting list because of improved symptoms. (<a href="https://ard.bmj.com/content/66/4/433">Weight loss</a> alone can significantly reduce symptoms from knee arthritis.)</p>
<p>Decision aids are not not commonly used for elective surgery in Australia but could be taken up more widely.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/326321/original/file-20200408-156764-krriim.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326321/original/file-20200408-156764-krriim.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326321/original/file-20200408-156764-krriim.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326321/original/file-20200408-156764-krriim.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326321/original/file-20200408-156764-krriim.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326321/original/file-20200408-156764-krriim.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326321/original/file-20200408-156764-krriim.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Surgery isn’t always the only option.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What will happen after the pandemic?</h2>
<p>We will obviously see an increase in elective surgery once the ban is lifted, but I predict the increase will not equate to the decline during this shutdown.</p>
<p>First, the demand for surgery is generated during surgical consultations, and these have declined considerably.</p>
<p>Second, financial strain will mean people will be less likely to agree to any out of pocket costs, and possibly fewer people will be insured. </p>
<p>Finally, people will realise they might not need the surgery. In effect, we may be “flattening the curve” of post-virus elective surgery partly by realising much of it can be avoided.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-steps-hospitals-can-take-if-coronavirus-leads-to-a-shortage-of-beds-134385">What steps hospitals can take if coronavirus leads to a shortage of beds</a>
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<p>But unless the forces that dictate our usual rates of elective surgery change, the rates will eventually return to normal. This is because we have a health system that drives specific, quantifiable treatments for diagnosed conditions.</p>
<p>For example, the system is geared at providing and reimbursing knee replacements, not the education, weight loss and exercise programs that might reduce the need for them. </p>
<p>There is considerable room to lower the rates of many common elective procedures, even without a forced shutdown.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-we-wait-so-long-in-hospital-emergency-departments-and-for-elective-surgery-54384">Why do we wait so long in hospital emergency departments and for elective surgery?</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/135325/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Harris does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Last month, Australia announced a pause on all elective surgeries. This could have mixed effects now and in the longer term.Ian Harris, Professor of Orthopaedic Surgery, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/995072018-07-15T18:46:52Z2018-07-15T18:46:52ZGetting an initial specialists’ appointment is the hidden waitlist<figure><img src="https://images.theconversation.com/files/227295/original/file-20180712-27042-lmlv0h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">States compare wait times differently so it's hard to judge the scale of the problem. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>The <a href="http://www.abc.net.au/news/2018-07-01/patients-waiting-more-than-16-years-for-hospital-treatment-in-sa/9929146">recent release</a> of specialist outpatient waiting times by the new South Australian government caused outrage when it was revealed some patients had been waiting more than 16 years for an appointment. </p>
<p>This is not a new problem. A <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquiries/1999-02/phealth_first/report/c02">2000 Senate Committee Report</a> cited consumer concerns about long outpatient waiting times, as did the <a href="http://www.parliament.qld.gov.au/documents/tableoffice/tabledpapers/2005/5105t4447.pdf">2005 Forster report</a> into Queensland’s health system.</p>
<p>Access to timely care is the cornerstone of an efficient and effective health-care system. Delays decrease patient satisfaction, prolong periods of pain and discomfort, and create uncertainty for patients. Worse, a patient’s health might deteriorate while waiting with an undiagnosed condition. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/which-are-better-public-or-private-hospitals-54338">Which are better, public or private hospitals?</a>
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<h2>Room for improvement</h2>
<p>Historically, much of the conversation on waiting times at public hospitals has been about elective surgery. While efforts <a href="https://www.aihw.gov.au/reports/hospitals/ahs-2016-17-elective-surgery-waiting-times/contents/table-of-contents">to report</a> and <a href="https://www.nsw.gov.au/news-and-events/news/shorter-wait-times-for-elective-surgery/">reduce</a> waiting times for elective surgery have been established nationwide, these figures only account for the time from a specialist appointment to the date of surgery. </p>
<p>This obscures the sober reality of even longer waits from GP referral leading up to the initial specialist appointment. This unreported wait is known as the <a href="https://www.theage.com.au/national/victoria/outpatients-wait-four-years-data-20100620-yp75.html">“hidden” waitlist</a>. </p>
<p>Currently, the quantity and quality of publicly available data on outpatient specialist clinics vary significantly between states, making it difficult to do national comparisons. Victoria has the most <a href="http://performance.health.vic.gov.au/Home/Category.aspx?CategoryKey=138#Anchor">comprehensive data</a>, reporting waits for the average patient, as well as how long the 10% of patients with the longest waits spent on the list for each specialty and urgency category. </p>
<p>While <a href="http://www.performance.health.qld.gov.au/Hospital/SpecialistOutpatient/99999">Queensland</a> and <a href="http://outpatients.tas.gov.au/clinicians/wait_times">Tasmania</a> have also published data on all referral categories, they use different measures. <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/our+performance/specialist+outpatient+waiting+time+report">South Australia</a> has only published average wait times for non-urgent referrals. </p>
<p>States also use different urgency categories to triage outpatient referrals. In Victoria, referrals are stratified into two categories based on queuing theory, which suggests the most efficient form of prioritisation is one with the fewest possible categories. Meanwhile, other states (WA, Tasmania and Queensland) function with <a href="https://www.qld.gov.au/health/services/hospital-care/waiting-lists">three priority categories</a>. </p>
<p>These different approaches to reporting make it impossible to compare states. Some 10% of patients wait more than three months in many Queensland clinics, and more than two months in Victoria.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/227271/original/file-20180712-27030-1a94b0s.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/227271/original/file-20180712-27030-1a94b0s.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/227271/original/file-20180712-27030-1a94b0s.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=443&fit=crop&dpr=1 600w, https://images.theconversation.com/files/227271/original/file-20180712-27030-1a94b0s.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=443&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/227271/original/file-20180712-27030-1a94b0s.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=443&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/227271/original/file-20180712-27030-1a94b0s.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=557&fit=crop&dpr=1 754w, https://images.theconversation.com/files/227271/original/file-20180712-27030-1a94b0s.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=557&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/227271/original/file-20180712-27030-1a94b0s.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=557&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Five comparable specialties in Queensland & Victoria with the longest waits.</span>
<span class="attribution"><a class="source" href="http://www.sourceurl.com">Queensland Health Quarterly information for Specialist Outpatient 2018, Victorian Health Services Performance Statewide Performance Data. Note: The clinically recommended wait time for Urgent (Category 1) patients is <30 days. The 90th centile wait time is the within which 90% of patients attended their first appointment.</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Why do such long wait times exist?</h2>
<p>The number of specialists available and the hours they choose to work in public hospitals affect the number of clinic appointments available. In aggregate, <a href="https://www.healthpolicyjrnl.com/article/S0168-8510(13)00076-6/fulltext">48% of specialists</a> work across both public and private sectors, 33% work only in public and 19% work only in private practice.</p>
<p>A <a href="https://www.publish.csiro.au/ah/ah15228">study</a> revealed that on average, orthopaedic surgeons and rheumatologists spend more than 70% of their time in private practice. Private practice generally offers higher incomes to doctors.</p>
<p>With such long wait times, patients who can afford it may turn toward <a href="https://www.mja.com.au/system/files/issues/206_04/10.5694mja16.01297.pdf">private specialist services</a> to skip the queue, leaving patients who cannot afford the <a href="https://www.smh.com.au/national/it-s-outrageous-doctors-slam-practice-of-blackmailing-patients-20180526-p4zhoe.html">high out-of-pocket costs</a> charged by specialists to wait. </p>
<p>The burden of <a href="http://www.abc.net.au/news/health/2018-05-28/how-out-of-pocket-medical-costs-can-get-out-of-control/9592792">out-of-pocket</a> costs also falls disproportionately on those with multiple diseases, the least disposable income and <a href="https://www.mja.com.au/journal/2013/199/7/cant-escape-it-out-pocket-cost-health-care-australia">older households</a>, excluding them from accessing more timely care in the private sector.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-why-do-australians-have-private-health-insurance-38788">Explainer: why do Australians have private health insurance?</a>
</strong>
</em>
</p>
<hr>
<h2>What can be done?</h2>
<p><a href="https://www2.health.vic.gov.au/Api/downloadmedia/%7B8946077D-7254-493F-B5C7-7886DD5ACE16%7D">Some health services</a> have implemented <a href="https://www.publish.csiro.au/ah/pdf/AH16275">strategies</a> to reduce outpatient waiting times. This can include using more <a href="https://www.publish.csiro.au/AH/AH16206">allied health services</a> where appropriate. For example, <a href="http://brochures.mater.org.au/brochures/mater-hospital-brisbane/orthopaedic-physiotherapy-screening-clinic">using physiotherapists</a> to see patients in orthopaedic clinics can help patients get non-surgical treatment for their condition earlier. </p>
<p>Other good solutions include a <a href="https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2011/vol-124-no-1347/article-cariga">non-contact first specialist appointment</a>, where a specialist looks at a patient’s clinical notes and sends their recommendation to the referring GP.</p>
<p>States need to address long outpatient waits. And they need to be accountable for doing so.</p>
<p>We need better data on outpatient specialist clinics accessible in all states. Ideally, the data reported would be based on a national standard, as we currently do for <a href="https://www.aihw.gov.au/reports/hospitals/australian-hospital-statistics-national-emergency/contents/table-of-contents">elective surgery and emergency services</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-private-patients-in-public-hospitals-a-problem-79910">Are private patients in public hospitals a problem?</a>
</strong>
</em>
</p>
<hr>
<p><em>Tessa Tan, Grattan Institute Intern and Bachelor of Medicine student contributed to this article.</em></p><img src="https://counter.theconversation.com/content/99507/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities as disclosed on its website.</span></em></p>Reports often talk about surgery wait times, but the time to actually see the specialist for the first time is the hidden waitlist.Stephen Duckett, Director, Health Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/642282016-10-30T19:06:52Z2016-10-30T19:06:52ZSurgery isn’t always the best option, and the decision shouldn’t just lie with the doctor<figure><img src="https://images.theconversation.com/files/142121/original/image-20161018-12454-11m0fyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Weighing up the evidence for surgery is just one thing to consider before going under the knife.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/dl2_lim.mhtml?src=G5r9D6sZtKvWkj3xzKlPTw-1-19&id=210890980&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Surgeons often decide to perform procedures because that’s what’s usually done, it’s what they’re taught, it sounds logical or it fits with observations from their own practice.</p>
<p>If the surgeon’s decision is in line with evidence from scientific studies, there’s little problem. But if the two conflict, either the surgeon’s opinion or the evidence is wrong.</p>
<p>The best way to test whether surgery works (particularly when the outcome is subjective, such as with pain) is to compare it with a sham or placebo procedure. The idea is to keep the patients and those who measure the effectiveness “blinded” to which treatment is given.</p>
<p>A <a href="http://www.bmj.com/content/348/bmj.g3253">review of studies</a> comparing surgery to sham or placebo surgery showed surgery was no better than placebo in just over half of the studies. And in studies where surgery was better than placebo, the difference was generally small.</p>
<p>As an example, two studies compared placebo surgery to keyhole surgery (arthroscopy) of the knee in patients with degenerative conditions (arthritis, meniscus tears and catching and clicking). Both studies showed no important difference in surgery outcomes between the two groups.</p>
<h2>What about other options?</h2>
<p>We don’t always need to compare surgery with a sham. Sometimes comparing surgery with non-surgical treatment (like physiotherapy or medications) is more appropriate.</p>
<p>One <a href="http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0096745">study</a> looked at all orthopaedic surgical procedures performed on more than 9,000 patients in three hospitals over three years. Only half the procedures were compared with non-operative treatment. And of that half, about half were no better than not operating.</p>
<p>So there are two problems in surgery: an evidence gap (in which there’s a lack of high quality evidence) and an evidence-practice gap (where there’s high quality evidence that a procedure doesn’t work, yet is still performed).</p>
<p>Part of the problem is that operations are often introduced before there’s good quality evidence of their effectiveness in the real world. The studies comparing them to non-operative treatment or placebo often come much later – if at all.</p>
<h2>When should surgery be funded?</h2>
<p>Doctors should not perform surgical procedures and taxpayers should not have to cover their cost until there’s high quality evidence they work. It should be unethical for surgeons to introduce a new technique without studying whether or not <a href="http://www.ncbi.nlm.nih.gov/pubmed/24484092">it works</a>.</p>
<p>Unfortunately, the opposite is true: ethical approval is not required before surgeons can start performing new procedures, but it is required to study the effectiveness of that procedure.</p>
<p>Often, procedures surgeons consider effective are later shown not to be.</p>
<p>In the US in the 1980s, a new procedure for the lung disease emphysema touted removing some lung tissue. Animal studies and (non-comparative) human studies were encouraging. So the procedure became common. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/142124/original/image-20161018-12459-vq1dx6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/142124/original/image-20161018-12459-vq1dx6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/142124/original/image-20161018-12459-vq1dx6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/142124/original/image-20161018-12459-vq1dx6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/142124/original/image-20161018-12459-vq1dx6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/142124/original/image-20161018-12459-vq1dx6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/142124/original/image-20161018-12459-vq1dx6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/142124/original/image-20161018-12459-vq1dx6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Weighing up the evidence for surgery could shed light on whether it should be funded.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/dl2_lim.mhtml?src=lfFyW8Ym2fcj54AIiy-Tfw-1-0&id=89667058&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Some surgeons called for a trial comparing the procedure to non-operative treatment. But proponents of the procedure said this would deprive many people of the procedure’s benefits, the effectiveness of which was obvious.</p>
<p>Medicare in the US decided only to fund the surgery if patients took part in a trial comparing it to non-surgical treatment. The <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa030287#t=article">trial</a> was done and the surgery was found wanting, with no overall benefit over non-operative treatment. The trial cost the government some money, but much less than paying for the procedure for decades until someone else studied it.</p>
<p>This type of solution should be considered in Australia: new procedures should only be funded by the public if they are performed as part of a trial to adequately test their effectiveness.</p>
<p>Once evidence is available, the key is using it to make good decisions about the effectiveness of a particular procedure for an individual patient. So how should surgeons do that? The answer lies in measuring the right outcomes to begin with and then making shared decisions.</p>
<h2>How do we know if surgery works?</h2>
<p><a href="http://www.theaustralian.com.au/national-affairs/health/budget-2016-healthcare-waste-costs-20bn-a-year/news-story/37475d4c7c3a7adfcd65b8216b8ed015">Billions</a> are spent worldwide on surgical procedures that may not be <a href="https://www.mja.com.au/journal/2012/197/10/over-150-potentially-low-value-health-care-practices-australian-study">effective</a>. But how should we define effectiveness?</p>
<p>There is a growing acceptance that doctors should partner with patients to identify outcomes important to them. These might include avoiding complications and an unexpectedly long stay in hospital. But they should also consider longer-term quality of life, disability and <a href="https://www.ncbi.nlm.nih.gov/pubmed/25689756">survival</a>.</p>
<p>This is important when a good operation might be a bad choice. Some medical conditions herald a terminal decline in health, for which living longer is not as good as living well. A good operation may also be a bad choice in cases where attempts at prolonging life are futile.</p>
<h2>Sharing decisions</h2>
<p>Shared decision-making takes into account beliefs, preferences and views of the patient as an expert in what is right for them, supported by clinicians who are the experts in effective therapeutic options.</p>
<p>Patients should have the opportunity to ask further questions when deciding whether to go ahead with surgery to see if surgery is consistent with their values and lifestyle goals. For the critically ill, frail or confused, this discussion should often include the person’s spouse, family or next of kin.</p>
<p>The right decisions in surgery are patient-centred, based on good evidence, clearly communicated and made in a supportive environment. Everyone – doctors, other health professionals, the patient, sometimes their family, and the public – have a right and a responsibility to be included.</p><img src="https://counter.theconversation.com/content/64228/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Harris receives no direct payment or funding for research projects. He is an investigator on research projects funded by NHMRC, HCF Research Foundation, AO Trauma Asia Pacific, Lincoln Centre, UNSW, Arthritis Australia, AOA Research Foundation, MAA and SIRA</span></em></p><p class="fine-print"><em><span>Professor Paul Myles receives research funding from the NHMRC and the Australian and New Zealand College of Anaesthetists. </span></em></p>There’s often limited evidence for many common types of surgery. Understanding what makes good evidence is the key to deciding what’s best for you.Ian Harris, Professor of Orthopaedic Surgery, UNSW SydneyProfessor Paul Myles, Chair of the Department of Anaesthesia and Perioperative Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/543842016-03-16T19:19:18Z2016-03-16T19:19:18ZWhy do we wait so long in hospital emergency departments and for elective surgery?<figure><img src="https://images.theconversation.com/files/115197/original/image-20160315-25507-lq3ekq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Clinicians prioritise patients based on the urgency of their treatment. But there's more to it than that. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/69422935@N00/4033995773/">painter dude/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Some situations can drive even the most patient person to meltdown. Try sitting in an emergency department for four hours on a Friday night with an injured relative. Or waiting two months for heart valve surgery, only for it to be cancelled at the last minute. </p>
<p>Waiting for emergency care, specialist appointments and “elective” procedures is not only inconvenient and frustrating, it can also be painful and detrimental to your health and well-being. </p>
<p>Spending on health care has grown rapidly in recent years. Approximately <a href="http://www.pc.gov.au/news-media/pc-news/pc-news-may-2015/improving-australia-health-system">10% of Australia’s gross domestic product</a> (A$147 billion in 2012-2013) is invested in these services annually. Of this, just under A$60 billion was spent on hospital services. </p>
<p>So why do we wait so long for hospital care?</p>
<h2>Waiting times</h2>
<p>The <a href="http://www.aihw.gov.au/hospitals/">latest available data</a> shows that half of all patients were admitted for elective surgery within 36 days of being placed on a waiting list and 90% of patients were admitted within 262 days. This means 10% of people waited longer than eight-and-a-half months. </p>
<p>These figures hide a great degree of variability, with 50% of people based in Queensland being admitted for surgery in 28 days and longer waits in New South Wales (49 days).</p>
<p>Almost three-quarters (73%) of Australians visiting emergency departments were seen within four hours. But, again, there is variation across states (62% in the ACT and Northern Territory, and 79% in Western Australia). </p>
<p>While it’s unlikely to provide much comfort, Australians don’t wait as long as in <a href="http://ac.els-cdn.com/S0168851013001759/1-s2.0-S0168851013001759-main.pdf?_tid=000dfb16-d8ee-11e5-913b-00000aacb35f&acdnat=1456095422_2188279a933e8e2665bbac50c186118f">some other</a> publicly funded <a href="https://www.mja.com.au/journal/2010/192/4/waiting-lists-and-elective-surgery-ordering-queue">health systems</a>. </p>
<h2>The efficiency argument</h2>
<p>Any economist will tell you that where there are finite resources, waiting lists can be a useful mechanism to enhance efficiency. They also ensure that someone really wants to access that service. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/115209/original/image-20160316-25507-1vvqwb1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/115209/original/image-20160316-25507-1vvqwb1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115209/original/image-20160316-25507-1vvqwb1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115209/original/image-20160316-25507-1vvqwb1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115209/original/image-20160316-25507-1vvqwb1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115209/original/image-20160316-25507-1vvqwb1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115209/original/image-20160316-25507-1vvqwb1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One-quarter of Australians visiting emergency departments aren’t seen within four hours.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-289814642/stock-photo-blurred-background-children-waiting-in-a-hospital-waiting-room.html?src=B0L3JUlROUvWFrA1eqQqMQ-1-26">Pammy Pammy/Shutterstock</a></span>
</figcaption>
</figure>
<p>Mediating the flow of people into services ensures scarce resources (medical professionals, beds, equipment) are in use as much as possible and highly paid clinicians and expensive machinery are not going unused for long periods. </p>
<p>This is particularly helpful in areas where it is difficult to estimate future demand – for example, where a town grows rapidly due to migration.</p>
<h2>Clinical need</h2>
<p>Efficiency is only one of the reasons we wait. Clinicians prioritise patients based on the urgency of their treatment, so those in greatest need can be seen soonest. </p>
<p>Few of us waiting in the emergency department for a suspected broken foot believe we should take priority over someone who has just been in a serious motorcycle accident and is struggling to breathe. Emergency departments aren’t “first come first served” because you will still be alive (albeit in pain from your foot) in a few hours, but the motorcyclist may not be. </p>
<p>In emergency departments, individuals are triaged into <a href="http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BN/0708/Hospitalwaitinglists#_ftn7">five categories</a>: </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/115192/original/image-20160315-9282-11r7op4.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/115192/original/image-20160315-9282-11r7op4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/115192/original/image-20160315-9282-11r7op4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=328&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115192/original/image-20160315-9282-11r7op4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=328&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115192/original/image-20160315-9282-11r7op4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=328&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115192/original/image-20160315-9282-11r7op4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=412&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115192/original/image-20160315-9282-11r7op4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=412&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115192/original/image-20160315-9282-11r7op4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=412&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>In relation to elective surgery, <a href="http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BN/0708/Hospitalwaitinglists#_ftn7">three categories</a> are used: </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/115191/original/image-20160315-9276-1fzqwpl.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/115191/original/image-20160315-9276-1fzqwpl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/115191/original/image-20160315-9276-1fzqwpl.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=280&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115191/original/image-20160315-9276-1fzqwpl.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=280&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115191/original/image-20160315-9276-1fzqwpl.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=280&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115191/original/image-20160315-9276-1fzqwpl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=352&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115191/original/image-20160315-9276-1fzqwpl.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=352&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115191/original/image-20160315-9276-1fzqwpl.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=352&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<h2>Disability while waiting for surgery</h2>
<p>The implications of waiting for surgery will depend on the procedure you are waiting for and a number of different life circumstances. Clinicians will apply judgements in different ways.</p>
<p>But how do we decide between someone who is classified as semi-urgent but is the primary carer for others, and someone who may have more urgent health needs but their waiting will not impact on others, or on their ability to work? </p>
<p>It’s not so clear cut. There is, however, evidence that longer waiting times for some procedures can result in <a href="http://www.sciencedirect.com/science/article/pii/S1063458409000818">greater costs for medication</a> and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191224/">poorer health outcomes</a> for older groups. </p>
<p>A number of countries have experimented with approaches that attempt to make decisions about where individuals are placed on surgical waiting lists <a href="https://www.mja.com.au/journal/2010/192/4/waiting-lists-and-elective-surgery-ordering-queue#12">more transparent</a>. Scoring approaches have been developed that seek to make the assessment process fairer. </p>
<p>But these kinds of approaches are unable to fully incorporate the differences and complexities of the lives we lead. And while they deal with the challenge of who goes where in the waiting line, they don’t actually reduce waiting times. </p>
<h2>So what can be done to help?</h2>
<p>Unfortunately, there isn’t just one solution when it comes to reducing waiting times. </p>
<p>Although many hospitals describe being <a href="http://www.abc.net.au/news/2015-02-25/some-victorian-hospitals-run-out-of-cash-on-weekly-basis-report/6260824">financially stretched</a> at the moment, it’s unlikely that providing additional money will solve this problem. </p>
<p>International evidence suggests that injecting more money into the health system <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3211737/">will not get rid of waiting times</a>. There are often more pressing needs within health systems. Even if resources are targeted at specific surgical procedures, for example, we may find an increase in demand because of reduced thresholds for treatment. </p>
<p>Some attempts have been made to incentivise people to take up private insurance so there is less demand on public hospitals. However, those who are able to take up private health insurance are typically healthier and wealthier, leaving those with complex and chronic illnesses relying on public hospitals.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/115211/original/image-20160316-25525-1x4snpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/115211/original/image-20160316-25525-1x4snpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115211/original/image-20160316-25525-1x4snpp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115211/original/image-20160316-25525-1x4snpp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115211/original/image-20160316-25525-1x4snpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115211/original/image-20160316-25525-1x4snpp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115211/original/image-20160316-25525-1x4snpp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Private health insurance hasn’t taken the pressure off the public system.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-177189656/stock-photo-interior-of-hospital-room-with-bed-and-chair.html?src=cLL9OZnEp_P7DBQgDgooJw-1-3">Tyler Olson/Flickr</a></span>
</figcaption>
</figure>
<p>Many systems have attempted to make performance data more readily available and to benchmark waiting times or set maximum waiting time indications. But while data can be helpful in identifying areas where there are particular challenges, and targets can incentivise organisations into action, they can also have perverse incentives. </p>
<p>The well-publicised initiative that individuals should wait no longer than four hours to be seen in emergency departments, for example, has largely been successful in bringing down waiting times. However, resources have be directed at those in danger of “breaching” these targets. Patients have been <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658273/">unnecessarily admitted</a> to hospital so they don’t continue to wait, but this may not be the most clinically appropriate or efficient outcome. </p>
<p>How we prepare, develop and support clinicians to make judgements about prioritising people’s treatment is crucial; it has profound impacts on the numbers of people referred for services. This is an issue that will continue to require attention, as will how we <a href="https://s3.amazonaws.com/msog-production/assets/files/000/000/351/original/MSoG_ManagementOfHealthServices2.pdf?1444616523">engage doctors</a> in the management and leadership of health-care organisations more generally.</p>
<p>The sad truth is there isn’t a silver bullet that will resolve this problem. Although waiting can be irritating, shorter waits do ensure that we use resources appropriately and, without a dramatic increase in funding, are likely to stay.</p>
<p>The challenge is to ensure that waits do not get so long that they have a detrimental impact on the quality of lives for individuals. </p>
<hr>
<p><em><strong>This article is part of our series <a href="https://theconversation.com/au/topics/hospitals-in-australia">Hospitals in Australia</a>. Click on the links below to read the other instalments:</strong></em></p>
<ul>
<li><p><strong><a href="http://theconversation.com/the-problems-with-australias-hospitals-and-how-can-they-be-fixed-54248">The problems with Australia’s hospitals – and how can they be fixed</a></strong></p></li>
<li><p><strong><a href="http://theconversation.com/infographic-a-snapshot-of-australias-hospitals-56139">Infographic: a snapshot of Australia’s hospitals</a></strong></p></li>
<li><p><strong><a href="http://theconversation.com/from-triage-to-discharge-a-users-guide-to-navigating-hospitals-54658">From triage to discharge: a user’s guide to navigating hospitals</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/how-much-seeing-private-specialists-often-costs-more-than-you-bargained-for-53445">How much?! Seeing private specialists often costs more than you bargained for</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/heres-how-to-boost-hospital-funds-and-end-the-blame-game-54247">Here’s how to boost hospital funds and end the blame game</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/what-are-better-public-or-private-hospitals-54338">What are better, public or private hospitals?</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/do-you-really-need-to-go-to-hospital-time-to-recentre-the-health-system-54406">Do you really need to go to hospital? Time to recentre the health system</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/no-one-should-get-dud-hospital-care-its-time-to-lift-our-game-on-quality-and-safety-54561">No-one should get dud hospital care – it’s time to lift our game on quality and safety</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/hospitals-dont-need-increased-funding-they-need-to-make-better-use-of-what-theyve-got-54815">Hospitals don’t need increased funding, they need to make better use of what they’ve got</a></strong></p></li>
</ul><img src="https://counter.theconversation.com/content/54384/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Dickinson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Waiting for emergency care, specialist appointments and “elective” procedures is not only inconvenient and frustrating, it can also be painful and detrimental to your health and well-being.Helen Dickinson, Associate Professor, Public Governance, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/452932015-08-04T04:21:42Z2015-08-04T04:21:42ZHospital patients are more likely to die at weekends but seven-day rosters are no panacea<figure><img src="https://images.theconversation.com/files/90546/original/image-20150803-6019-1yekxy5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">England's NHS is taking implementing seven-day services in an attempt to reduce excess deaths on weekends. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-191114228/stock-photo-room-with-two-beds-in-the-hospital.html?src=yxPQFULKTUvPRD9vg4pROg-1-112">www.shutterstock.com</a></span></figcaption></figure><p>If you are admitted to a hospital on the weekend, you have a higher chance of dying than if you are admitted during the week. This is known as the “weekend effect”.</p>
<p><a href="http://jrs.sagepub.com/content/105/2/74.abstract">Evidence from the United Kingdom</a> suggests an 11-16% increased risk of death for patients admitted on weekends, mostly driven by emergency admissions. This effect has also been found in <a href="http://www.sciencedirect.com/science/article/pii/S0002934304002475">the United States</a> and <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1445-5994.2009.02067.x/full">Australia</a>, among Queenslanders admitted for heart attacks.</p>
<p>But while seven-day rosters for doctors and nurses have been touted as a solution to this problem in the UK, the evidence suggests it’s a little more complicated. </p>
<h2>What causes the weekend effect?</h2>
<p>Generally, there are fewer routine elective procedures and outpatient appointments scheduled on weekends. This means there are fewer nurses and doctors available for emergency care. </p>
<p>During the week, for example, heart surgeons working on elective procedures in hospitals can easily be called away to treat patients admitted through the emergency department. These surgeons may be less readily available at weekends when there are no elective surgeries or outpatient appointments. And there may be longer delays for them to be called in to the hospital for emergency cases.</p>
<p>There is some <a href="http://www.nejm.org/doi/full/10.1056/nejmoa063355">evidence from the US</a> to support this explanation. Researchers found that a weekend effect for patients presenting with a heart attack (acute myocardial infarction) disappears when they control for the use of invasive treatments such as cardiac catheterization or coronary artery bypass graft (heart bypass). </p>
<p>This suggests that a lower “treatment intensity” for patients presenting at the weekend explains their higher chance of death.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/90540/original/image-20150803-5978-7b5vx7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/90540/original/image-20150803-5978-7b5vx7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/90540/original/image-20150803-5978-7b5vx7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/90540/original/image-20150803-5978-7b5vx7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/90540/original/image-20150803-5978-7b5vx7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/90540/original/image-20150803-5978-7b5vx7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/90540/original/image-20150803-5978-7b5vx7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Surgeons may be less available for emergency procedures on weekends, and there can be longer delays for urgent operations.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/isafmedia/3424052022/in/photolist-6dzanG-6LyK5M-9866ZQ-7x8Ge-9e7G55-7x7iS-6fv9gA-dgSLw2-4jFUbM-tx6wP8-odAUX-shNHJF-dgSLKj-aw9eaM-s2qrRV-dgSLCS-dRp8pk-cDXWXC-8SNxMK-rQvc4W-8Mzmie-oYLAdr-hRLTUV-9b2ckU-fHc3B-9eC7PJ-bq7jUk-aJPKGK-eeVK74-55E23R-ni2HEj-qtWa9C-qannsh-o1vDW1-o3oLa4-Bqkyh-e5hpLQ-6dUkD9-5XGMui-giVXpA-9uuNjp-4AKLvA-48Svrw-aaEKnv-adtz2R-5Adove-65J2QU-bq8JVa-5zYqyR-dr2tf5">ResoluteSupportMedia/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>What policies could address this problem?</h2>
<p>Policies to address the imbalance of service and workforce availability between weekdays and the weekends should help to alleviate the weekend effect. </p>
<p>The most comprehensive solution would be to introduce seven-day availability of all types of hospital services, scheduling elective procedures and outpatient appointments on weekends as well as weekdays. This would essentially mean having no difference in the type of care offered on different days of the week.</p>
<p>The UK National Health Service (NHS) is <a href="http://www.nhsiq.nhs.uk/7860.aspx">taking steps towards</a> implementing seven-day services in England, which has <a href="http://www.theguardian.com/society/2015/jan/02/nhs-seven-day-service-threaten-patient-safety-doctors">generated a heated debate</a> between doctors, NHS managers and politicians on the merits of this proposal.</p>
<h2>Costs and benefits of seven-day services</h2>
<p>Health bureaucrats looking to address the imbalance between weekend and weekday service availability may try to redistribute the existing workforce supply to be evenly spread throughout the week. </p>
<p>This redistribution of services and workforce should reduce the death rate for weekend admissions. But it would come at the cost of potentially increasing the death rate (and other adverse outcomes) on weekdays where there would be a reduction in services.</p>
<p>Such a redistribution would also involve an increase in financial cost, as higher levels of pay are likely to be necessary to encourage doctors and nurses to work more of their hours at weekends. One of <a href="http://www.sciencedirect.com/science/article/pii/S0167629612000902">our recent studies</a> suggests that junior doctors in Australia would expect a 25-50% increase in salary to sacrifice control over their working hours and/or be available for more frequent on-call time. </p>
<p>A <a href="http://hsr.sagepub.com/content/20/1/31.long">similar study</a> finds a premium of 10-15% of salary is needed to encourage nurses to work at weekends as well as on weekdays.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/90547/original/image-20150803-5978-2ofi0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/90547/original/image-20150803-5978-2ofi0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=384&fit=crop&dpr=1 600w, https://images.theconversation.com/files/90547/original/image-20150803-5978-2ofi0y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=384&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/90547/original/image-20150803-5978-2ofi0y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=384&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/90547/original/image-20150803-5978-2ofi0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=482&fit=crop&dpr=1 754w, https://images.theconversation.com/files/90547/original/image-20150803-5978-2ofi0y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=482&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/90547/original/image-20150803-5978-2ofi0y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=482&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Seven-day services could reduce the death rate for weekend admissions, but would come at a cost.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-48064288/stock-photo-doctor-using-scrubs-walking-at-the-hospital-corridor.html?src=IFSfJX8XnIVP5YIawchb-w-3-113">Julian Rovagnati/www.shutterstock.com</a></span>
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<p>An <a href="http://onlinelibrary.wiley.com/doi/10.1002/hec.3207/abstract">important paper</a> has recently tried to quantify the costs and benefits of introducing seven-day services in the UK. It calculates the potential “lives saved” by eliminating the weekend effect and uses cost estimates produced by hospitals which have been trialling seven-day services. </p>
<p>The authors are able to quantify “cost-effectiveness” by comparing the cost per year of life saved (implied by their analysis) with the National Institute for Clinical Excellence’s “cost-effectiveness threshold” for life-years saved. This is generally thought to be around £20,000 per life year. </p>
<p>The authors find that introducing seven-day services does not come close to cost-effectiveness. The cost of avoiding excess deaths from weekend admissions is too high relative to other effective interventions the NHS could spend its money on.</p>
<p>At the heart of this debate is a trade-off between equity and efficiency. It is more “efficient” to have less service availability at weekends and more on weekdays, because of the increased costs associated with employing doctors and nurses at weekends. But we have to decide if we are willing to accept the resulting inequity: that patients admitted on weekends may have a poorer access to care and a resulting increase in mortality.</p>
<h2>Should Australia move to seven-day services?</h2>
<p>The debate over seven-day services in the UK <a href="http://www.telegraph.co.uk/news/11500692/David-Cameron-Tories-will-create-a-truly-seven-day-NHS.html">is highly politicised</a>, and influenced by the current government’s agenda to make the NHS more patient-focused. </p>
<p>We have a different health-care system and political climate in Australia and are yet to have this debate. With a much larger private sector and public hospitals run by state governments, there is not a single national focus for policy debate about public hospital services. </p>
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<img alt="" src="https://images.theconversation.com/files/90543/original/image-20150803-5983-6tdkt7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/90543/original/image-20150803-5983-6tdkt7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/90543/original/image-20150803-5983-6tdkt7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/90543/original/image-20150803-5983-6tdkt7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/90543/original/image-20150803-5983-6tdkt7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/90543/original/image-20150803-5983-6tdkt7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/90543/original/image-20150803-5983-6tdkt7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">In Australia, we have not had the debate on seven-day hospital services.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-112477955/stock-photo-surgery.html?src=IFSfJX8XnIVP5YIawchb-w-2-145">www.shutterstock.com</a></span>
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<p>Nevertheless, the current evidence from abroad suggests that forcing hospitals to provide all services equally distributed through the week is not the answer. </p>
<p>While the weekend effect on mortality may seem large in relative terms (10-16%), it is tempered by the low mortality rate in absolute terms. The 10% relative increase of death in the UK data translates to only 0.4 percentage points (3.7% on weekdays vs 4.1% on weekends for emergency admissions).</p>
<p>Further, the <a href="http://onlinelibrary.wiley.com/doi/10.1002/hec.3207/abstract">cost-effectiveness study</a> from the UK highlights the potentially high costs of seven day services in relation to any health benefits. Further research is needed, especially on the cost side and in understanding the drivers of the weekend effect in different clinical areas of patient care.</p><img src="https://counter.theconversation.com/content/45293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Sivey currently receives funding from the Australian Research Council and has previously been funded by the National Health and Medical Research Council, the Department of Health (Victoria) and Health Workforce Australia.</span></em></p>If you present to a hospital on the weekend, you have a higher chance of dying than if you present during the week. This is known as the “weekend effect”.Peter Sivey, Senior Lecturer, Department of Economics and Finance, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.