Options for patients without private health insurance. Dr Leon Cohen talks about the current situation regards getting weight loss surgery as a public patient in Perth WA.
Bariatric Surgery for Public Patients
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Video Transcription
What if a patient doesn’t have private health insurance?
Dr. Leon Cohen: Well, bariatric surgery in the public centre at the moment is very limited. So Joondalup Hospital has a modest bariatric program and I think they’re allowed to do two or three hundred cases a year.
A lot of their case load is swamped by patients who’ve previously had bands and have had complications with the bands and they’re trying to fix those problems up.
In practical terms, you’re probably going to wait two or three years just to be seen in one of their clinics and another period of waiting a year or two just to get on their waiting list. So if patients don’t carry private insurance, we recommend a number of things.
The first is, take out private insurance. Wait a year and then you will be ready to have your surgery.
The second is that it is actually possible to access your superannuation account if you have money in that account, sufficient money, which can pay for the whole surgery or for the gap which is for us, around $6,000 to $7,000 on top of any private insurance that you have.
Additionally, a number of our aboriginal patients from up North have been able to benefit from various land rights monies that have been allocated to improve their health. And this is a legitimate use of it.
The reason that this surgery is not being done as it should be in public hospitals I think is largely due to this insane mismatch between the Commonwealth funding for health and the state funding for health. So the benefits – the Commonwealth pays for Medicare for the GP practices and for the drug budgets. The state is responsible for just about everything else including the running of the hospitals where the surgery can be done.
The benefit in terms of cost saving from bariatric surgery is in the reduced GP attendances and the reduced drug bill. And that’s a saving of about $10,000 a year just for a diabetic. So all the benefit flows to the Commonwealth but the expense for doing the surgery would be have to incurred by the state hospitals.
And their accountants and managers look at the expense of doing a bariatric operation, again, about $10,000 and they say, “Why should we be spending this money when we’re getting none of the benefit? Why should we be spending this money when we’ve got all the calls on our purse to carry out a cancer surgery or a service or a trauma service or a joint replacement service?”
And so, I tried for many years to get bariatric surgery into the public hospital where I worked. It was rejected. The compromise has been that there is one hospital doing it, Joondalup. They have a very limited service.
In practical terms, when you consider that there are probably over a million people in Australia who have a BMI over 35 who could do and should do put their hands up for bariatric surgery even if they turned all of the public hospitals full-time into doing bariatric operations, they wouldn’t be able to break the back of that.
Bariatric surgery is not the answer on a population level for the problem of morbid obesity. It can’t cope with the number of operations that we need to do. But for the individual, it is the best approach. And that’s why we continue to do it for those people who are lucky enough, determined enough, and have the resources to do it.
What’s the process of someone wanting to have the surgery?
Dr. Leon Cohen: So first of all, because we’re specialist centre, a patient must get a referral from their general practitioner. And we continue to interact with their general practitioner and keep them informed of the process. Then they make an appointment to see either myself or one of my associates, Dr. Valibhoy or Dr. Boyt, for the initial consultation. See how to get started.
That initial consultation usually takes place over about half an hour to 45 minutes, and that’s where we want to find out more about them, about their pattern of obesity, their weight history, what illnesses they have. It’s the time when we have a discussion about the pros and cons of the operation and the potential risks.
And most importantly, try and determine what the patient’s goals are, what weight they would like to be, where they see themselves in a year or two’s time. Because it’s very important that we are sure that we can match up their expectations to what we actually can deliver, and that people don’t have unreasonable and unrealistic expectations one way or the other about what their final weight is going to be.
Mercy Bariatrics Perth
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