What does a DIEP flap cost? And how does the cost of a DIEP flap in Australia compare to other countries?
Depending on the situation, the provision of surgical services in Australia may be covered in part by Medicare, in part by Private Health Insurance providers, and in part by out of pocket costs borne by patients. Surgeons are free in Australia to set their own fee (unlike in the UK, where insurers set the fees for procedures) and given that the reimbursement for surgical procedures in the Medical Benefits Scheme have not kept pace with inflation and the costs of provision of those services, most private patients will expect a certain out of pocket expense.
Whilst the cost of procedures such as a DIEP will vary from surgeon to surgeon, most of us are governed sufficiently by our own personal ethics to limit the expense to patients. But if we look at the reimbursement for a procedure such as a DIEP from Medicare alone, how do we compare to other countries around the world? And more importantly, is the reimbursement (or lack thereof) a driver of the choices your surgeon will (or will not) offer you with regards your breast reconstruction?
In the current issue of the Journal of Plastic, Reconstructive & Aesthetic Surgery, a rather interesting article has been published. Co-authored by Phillip Blondeel, the paper attempts to make comparisons between major centres in Europe, America and Australasia with regards to the reimbursement to surgeons performing DIEP flap procedures. In Australia, this is really only relevant when the procedure is performed in the Private setting, as DIEP flaps performed in the Public system attract reimbursement to the hospital only, and not to the surgeon (who receives rather a salary or hourly wage). What we see in this paper is that Australia sits somewhere in the middle if we consider only the reimbursement provided to surgeons. If we then consider the reimbursement in the context of cost of living, this pushes Australia further down the rankings into the realms of chronic underfunding for DIEP flap procedures. We find ourselves 6th from the bottom in a survey of 17 countries, despite having the second highest cost of living from the same group based on our purchasing power parity (PPP).
So what does this mean to our patients?
Well, hopefully nothing. We could hope that the relatively low reimbursement provided for a DIEP flap reconstruction does not serve to dissuade surgeons from providing this procedure. We could hope that the DIEP flap, which is the accepted gold standard in breast reconstruction, is offered to all women equally based on their individual requirements.
But we also know that there are many more implant based reconstructions being performed worldwide than DIEP flaps. Whilst exact figures for Australia are hard to come by, internationally, autologous tissue reconstruction of any form represents a minority of breast reconstructions. DIEP flaps, which have a significant learning curve and are technically demanding procedures, constitute an even smaller proportion.
So, if the DIEP flap is accepted as the gold standard against which other reconstructions must be compared, then why are more not being performed?
Healthcare economics is a thorny issue. Every country that maintains a taxpayer funded health system (whether augmented by private insurers or not) is struggling with the ever increasing costs of providing healthcare. Australia is no different. The priority however must continue to be providing the best care to our patients.
Cost savings measures are vital in the current financial environment, but surely, in order to save dollars in the health budget, we must be examining the vast waste and inefficiency in our public health care system, rather than trying to screw the system for every penny by decreasing the value of surgery. One can only hope that politicians understand the difference between these approaches.
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