An Ottawa doctor says Ontario's push to expand access to weight-loss surgery in the province is leading to longer wait times because of stricter rules on covering out-of-province procedures.
Dr. Yoni Freedhoff treats obese patients and has five people on the provincial wait list for bariatric procedures, such as gastric bypass surgery.
He said that last year, he routinely referred patients to the United States for surgery, where it could be performed within four months of booking an appointment.
But last spring, the province announced it would spend $75 million over three years to increase the number of bariatric surgeries in the province from 244 in 2008 to 1,470 a year by 2011-12. Ottawa Hospital is one of five facilities capable of performing the procedures.
The Ontario Health Ministry said that in 2008-09, the province funded close to 3,000 patients for out-of-country bariatric procedures. The ministry said doing the procedures in Ontario would save the government about $10,000 per procedure. The case cost for bariatric surgery in Ontario is $17,200 — that includes pre-operative assessment and preparation by a multi-disciplinary team, surgery and inpatient costs (including complications, if any) and post-operative follow-up for 5 years.
Freedhoff said that as part of the expansion of services, the province also made it harder for out-of-country procedures to receive provincial funding. He said adopting stricter requirements before the province's program is running at full capacity has caused the wait list to balloon to over 1,200.
It could take as long as two years for some patients to get the surgery.
"People have medical problems that will be cured by this procedure — diabetes, high blood pressure, high cholesterol problems — where this procedure will markedly improve their likelihood of living," Freedhoff said. "So we are going to have people die on a wait list because we are trying to figure out a way to do this in Ontario."
Freedhoff said it's "wonderful" that Ontario is expanding access to the procedure in the province, but asks "why shut the floodgates to the [United] States?"
Funded out-of-country procedures drop
While the floodgates haven't been shut, they have certainly been constricted. From April 1 to Aug. 31 this year, the province has approved only 24 patient applications for out-of-country bariatric procedures.
The previous year — from April 1, 2009 to March 31, 2010 — 1,479 out-of-country patient applications were approved. In 2008-09, 2,944 applications were allowed.
Ministry spokesman David Jensen said the rules for eligibility for funding out-of-province surgery haven't changed, but one of the factors for deciding whether to fund these procedures is if an equivalent service exists in the province.
If an equivalent service does exist, the standard is that the procedure is "necessary for the insured person to travel outside of Canada to avoid a delay that would result in death or medically significant irreversible tissue damage."
Surgery comes with risks
Dr. Robert Dent, who heads the weight management program at the Ottawa Hospital, said in addition to the extra cost of sending someone to the United States, bariatric surgery is a major procedure, and as such comes with risks.
In the most common form of the surgery, gastric bypass, a surgeon reduces the capacity of the stomach to hold food, greatly reducing a person's appetite and in turn leading to quick weight loss, as much as 70 per cent of excess weight within the first year.
Dent said if there are complications with a surgery performed abroad, it can be more difficult for Canadian medical staff to treat the problem.
"We get them in the emergency room at 4 a.m. on a Sunday … we have no operative report … we often can't get in touch with the [American] surgeons," said Dent. "So that person who has surgery in the U.S. is at a big-time disadvantage … a very risky one."
Dent said his clinic is now referring patients to Toronto hospitals, where the wait time is less than a year.