Robotic prostate surgery: a health care conundrum

Story by:
VANCOUVER— From Friday’s Globe and Mail
Published Thursday, Dec. 09, 2010 8:54PM EST

Just six weeks ago, Rob Lucy had his cancerous prostate gland removed by a surgeon-controlled robot at Vancouver General Hospital. It cost him nothing.

If his operation had been booked for the new year, however, Mr. Lucy would have had to shell out more than $2,800 from his own pocket for exactly the same procedure.

via Robotic prostate surgery: a health care conundrum – The Globe and Mail.

The above was the story describing an upcoming charge for patients undergoing robotic prostate surgery in Vancouver. Below is an excerpt from an article in the vancouver Sun.

The health authority has cast these fees as being in the same category as other elective upgrades that patients are asked to pay for now, such as lighter fibreglass casts.

It argues that patients can choose conventional surgeries at no cost if they prefer, as required under the Canada Health Act.

But this justification depends on two conditions: first that there is no therapeutic advantage to the robotic procedures and second, that there is, in fact, a real choice.

It’s not clear whether the first condition has been met. Sun health reporter Pamela Fayerman reports that while the ultimate outcome is no different, patients who choose the robotic route need less blood during operations, need less hospital time and recover more quickly.

If those benefits are expected to outweigh the costs for individuals who can afford the robotic route, they should also be enough to qualify for public funding, especially as we expect there is still a research value attached to exploring mechanically assisted surgery.

The question of real choice is equally problematic.

via Charging patients for robotic surgery breaks new ground.

The Canadian system of healthcare offers equivalent care for all which the government pays for (Through a tax).  Robotic surgery is more expensive in Vancouver and patients are being asked to pay part of the cost.

The reporter brings up the dilemma that if the robotic surgery is better, than it should be paid for.  If it is not better, then it shouldn’t be performed.  Robotic surgeons typically perform more surgeries than conventional surgeons at specialty centers.  This may mean someone would need to pay extra for the more experienced surgeon.

These are interesting issues to consider as our health care system in the US is heading towards more governmental involvement. Is healthcare a right and should it be paid for by the government for all through taxes? If we think that it should be paid for for all patients as it is in Canada, can we afford to give every patient the best care?

Profitability of Robotic Surgery: Hospital Perspective

Analysis: Robot’s financial impact mixed

Whether a hospital can break even or make a profit with the da Vinci
device appears to turn on factors like the specific health plans in a
particular market, the mix of Medicare patients, and the efficiency in
using the robot. And most facilities seem to lose money at the outset.

“The da Vinci system makes you a better surgeon,” Arieh Shalhav,
associate professor of surgery and director of minimally-invasive urology
at the University of Chicago, told United Press International.

I am extremely pleased that Dr. Shalhav has become one of the top minimally invasive surgeons in the United States. As a 3rd year urology resident in 1999 I had the fortune of working with Dr. Shalhav. He was an excellent teacher and was the first exposure I had to minimally invasive urology. We spent time together performing research in the lab and surgery in the operating room. The majority of the reason why I have been as successful as I have with minimally invasive surgery is what I learned from Dr. Shalhav and the other world class surgeons at Indiana University.

Source: United
Press International

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