Obesity surgery should be equally available for all eligible Australian patients, via the public health system, according to an editorial published in the Medical Journal of Australia.
Professor Michael Edye, Professor of Surgery at the Blacktown Clinical School of the University of Western Sydney, and Dr Michael Talbot, Senior Lecturer in the Department of Surgery at St George Hospital in Sydney, wrote that evidence is growing that patients who undergo bariatric surgery in the public system have outcomes equally favourable as those who have the surgery in the private system.
“[And yet], Australia still has no framework within which obesity treatment of any kind, including surgery, can be offered to all”, Edye and Talbot wrote.
Even in states where bariatric surgery is available publicly, “services are poorly funded and oversubscribed”, they said.
Evidence also exists showing that the cost of surgery can be offset by savings due to the decreased need for treatment and medications for obesity comorbidities such as type 2 diabetes.
“Uncontrolled” bariatric surgery in the public sector could lead to increased waiting list times and budgetary overruns from “hospital readmissions for revisional surgery and complication management”, the authors wrote.
One solution, they said, was to “focus on surgery to treat sickness rather than fatness”.
“Body mass index alone is not as good a selection criterion as the presence of serious obesity-associated conditions that are inadequately responsive to standard medical therapies”, they wrote. “In this setting, bariatric surgery is best practice.”
The authors proposed that instead of selecting patients just by BMI, the final recommendation for surgery should be based on the presence of serious accompanying conditions such as diabetes and “made in a multidisciplinary team-like structure” to ensure cost-effectiveness and patient compliance.
They also recommended public-private collaborations between surgeons and local health district clinics to ensure the case volume and personnel needed to impact on patient numbers, as well as the implementation of the Monash University-based Bariatric Surgery Registry, and input from national e-health records and wearable fitness tracking devices.
“The challenge will be to achieve buy-in by bean counters and bariatric surgeons with the acknowledgement that life-threatening complications of severe obesity merit best-practice treatment”, the authors concluded.
Inequalities of access to bariatric surgery in Australia, Michael Edye MB BS, FRACS, FACS Professor of Surgery, Michael L Talbot MB ChB, FRACS Senior Lecturer, Medical Journal of Australia, doi: 10.5694/mja14.01169, published 3 November 2014.
Source: Australian Medical Association (AMA)