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DAY SURGERY - a golden opportunity for the private sector?
publication date: Feb 11, 2009
From Switzerland to Bulgaria, day surgery faces big barriers. So just how much day surgery does go on across Europe? That is an increasingly pertinent question, as healthcare budgets come under growing scrutiny. The short answer appears to be: not as much as you might expect. Which makes the area a huge opportunity for the private sector, already a powerful force in ambulatory centres in most countries. So what are the problems? Apparently, mandatory social insurers often just don’t get the concept. Indeed, we were told by a private operator in Bulgaria that he had to tell his day surgeon patients to lie to the National Health Insurance Fund, which won't pay out unless patients have had three days in bed for some fairly minor interventions: “We can do great day surgery, and get great results, but we still have to lie!” The same issues arise in far more advanced markets. Ian Jackson, past head of the British Association of Day Surgery, sits on the general assembly of the International Association for Ambulatory Surgery, and has travelled around a lot. He says: “Germany has issues about funding being linked to lengths of stay, which is causing problems rather like you describe. The last I heard, Switzerland had similar issues, which was making some previously keen surgeons sound very depressed.” Elsewhere, the medical profession is still not embracing the concept. I talked to Attila Olah, who runs healthcare insurance at ING Hungary. He said: "Here, there is much resistance to day surgery from the medical profession, although the government is increasingly keen on it." Jackson continues: "In the UK, we are still scratching the surface of what is possible around the country. Scotland and Wales are way behind, but both are now trying to move this forward. Though we are ahead of the game to a degree in England, there is still huge variation around the regions, and so much more that can be done.” Institutional resistance to day surgery has been pretty intense in Western Europe. Done properly, it calls for dedicated operating theatres, staff who work different shifts and different hours from the norm, and different ward set ups. Resistance in East European public sector hospitals to such changes is likely to be intense- which is exactly why it should be a big opportunity for the private sector. There are some interesting stats on day surgery rates for different treatments from the International Association of Ambulatory Surgery: click here to get to their home page , and then click on 'initiatives' to access the survey. This shows that in 2005 there were some pretty big differences in the public sector between the UK, France and Germany. |
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