Australian Prime Minister Scott Morrison has announced some elective surgery can start again in private hospitals, as it becomes clear the health system will cope with the additional coronavirus demand.
He said 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.
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.
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.
Category 1, Category 2, Category 3: what’s the difference?
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.
States have not yet announced their plans for restarting elective surgery.
Category 1, the most urgent, is where patients should be seen within 30 days
Category 2 patients should be seen within 90 days
Category 3 patients should be seen within 365 days.
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.
Different surgeons can assign patients different categories
Unfortunately, different surgeons seeing the same patient may make different assessments of what category they should be in. This policy issue needs to be addressed.
If you are scheduled for an operation in a private hospital, either the hospital or the surgeon will contact you.
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.
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.
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.
But we have to act quickly if we are to change how we manage these wait lists, as federal Health Minister Greg Hunt wants a staged reintroduction to begin on April 27.
Currently, elective surgery is classified 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.
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 Adam Elshaug and I have argued before.
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.
A properly managed elective procedures system should have three key elements:
there should be a consistent process for assessing a patient’s need for the procedure, and ranking that patient’s priority against others
the team performing the procedure, and caring for the patient afterwards, should be highly experienced in the procedure
the procedure should be performed at an efficient hospital or other facility, so the cost to the health system is as low as possible.
Unfortunately, Australia sometimes fails on all three measures.
Stop the inconsistencies
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.
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.
Patient characteristics, such as gender or level of education, also seem to inappropriately affect categorisation decisions.
Yet most states ignore these facts. They have done little to rationalise services for the benefit of both the patient and the taxpayer.
Time for change
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.
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.
Private health insurers should be empowered to participate in funding diversion options so patients are able to have their rehabilitation at home rather than in a hospital bed.
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.
They could refuse the offer, without losing their place in the queue, if they wanted to wait for a closer location.
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.
Patients with private health insurance can opt to be treated as a private patient in a public hospital. So the waiting list should include public and private patients, to prevent private patients gaining faster admission to public hospitals.
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.
States should consider signing contracts with private hospitals, at or below the public hospital efficient price, for elective procedures to be performed in these hospitals to help clear the elective surgery backlog.
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.
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.
The trial of Uzbekistan Christian Aimurat Khayburahmanov was to restart on the 23rd September 2008. He has been charged for teaching religion without official approval, and establishing or participating in a religious extremist organisation. If found guilty, Khayburahmanov could be jailed for up to 15 years.
It is illegal to conduct any type of evangelistic or missionary activity in Uzbekistan.