One-off funding packages and elective surgery blitzes won’t work, says RACS

MedTech News: The Royal Australasian College of Surgeons (RACS) has used its pre-Budget submission to urge the Albanese Government to invest in timely access to surgery in public hospitals, a private sector that continues to alleviate pressure on public waiting lists, and equity of care in remote and rural areas.

The latest report from the Australian Medical Association (AMA) indicated that the number of people waiting for elective surgery across public hospitals is swelling and is expected to reach more than 500,000 by mid-year, if no action is taken by governments. 

The RACS pre-Budget submission calls for a national plan for elective surgery and a review of elective surgery urgency categories, including the term ‘elective surgery’.

“A plan is needed to restore equitable and timely access to elective surgery as the number of procedures returns to the long-term trend. One-off funding packages and elective surgery blitzes will not be enough to address the impact that the last three years have had on the already stressed health system and its capacity to deliver care for patients into the future. Similarly shifting public workload into the private sector is not a medium or long-term solution to public hospital waiting lists.

“The view that certain procedures are not ‘urgent’ based on the fact that they may be ‘category 2’ or ‘category 3’ has caused immense frustration amongst patients and doctors and impacted on clinical outcomes. An elective procedure is not an optional procedure that a patient elects to have or a doctor
elects to deliver – it is essential surgery. It is surgery to address often life-threatening conditions and conditions that prevent patients from living a normal life because of severe pain or dysfunction,” the College said.

The mix of public/private healthcare is under significant stress. According to RACS, measures to encourage private health insurance and reduce reliance on public hospitals will need to be part of the solution.

The Australian Medical Association (AMA) released its annual Private Health Insurance Report Card in January 2023, calling on health insurers to deliver value for money for policyholders.

In its submission, RACS also expressed concerns about moves towards US-style managed care. The College said it is concerned that some believe moving toward a US-style ‘managed care’ private health system is the way forward. Despite the significant lobbying from the AMA and other medical associations against US-style managed care, the ACCC authorised Honeysuckle Health and nib Health Funds to form and operate a health services buying group in September 2021.

“Under managed care a network of healthcare providers including surgeons are selected by an entity such as a private insurer or buying group, restricting patient and doctor choices about providers. RACS’ concern is that moves toward managed care will restrict patient choices, reduce quality of healthcare, and limit medical practitioners’ autonomy,” the College said.

It is RACS’ position that the government should work with stakeholders to ensure that the private sector continues to alleviate pressure on the public system. Private health insurers, private hospitals, device importers and manufacturers, and private specialists – represented by RACS and other peak bodies – will all need to be consulted.

In relation to expanding surgical services in rural areas and for Aboriginal and Torres Strait Islander communities, there are significant gaps that need to be addressed. While 29% of Australians live in rural and remote locations, only 12% of RACS Fellows (FRACS) live and work rurally in Australia and for five of the nine surgical specialties, less than 5% of Fellows are based outside cities.

The reasons for this maldistribution are multifaceted. RACS has acknowledged that some of RACS’ own policies and systems are barriers, for example in relation to selection of trainees. RACS is addressing these barriers under the RACS Rural Health Equity Strategy, adopted in 2020.

However, there are key barriers which only the government can address. RACS’ position is that as the National Medical Workforce Strategy (NMWS) is implemented, a long-term mechanism must be put in place to address the specific barriers to attracting and retaining surgical trainees and surgeons in rural areas. Some barriers to being based in rural areas may be faced by all doctors, for example a lack of reserved day-care and school positions, others such as unsafe on-call rostering hours may be a particularly important issue for surgeons and other specialists.

In April 2022, the College secured $850,000 over two years to fund a project to investigate and address barriers to rural hospitals being accredited to carry out surgical training. 

“To enable more rural hospitals to offer surgical training posts we will begin by researching barriers rural hospitals encounter when they apply for surgical training accreditation and carry out consultations to gather first-hand information,” said Associate Professor Kerin Fielding, Chair, Rural Health Equity Strategy Committee.

RACS will publish a report on its findings and provide recommendations on what can be improved for surgical services within remote and rural areas.

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