shanwow1
Active member
This article on the front page of The Province (newspaper here in Vancouver, BC) caught my eye as I was leaving a restaurant last night. I have posted the text below in case the link doesn't work. I think there a some facts missing from this article, but the underlying argument about Universal Healthcare is an interesting one. Call me a socialist but I'd personally take the Canadian system over the US system any day. Also, the last line is particularly interesting. Thoughts/Opinions?
http://www.theprovince.com/news/declared+healthy+alternative+open+heart+surgery/9409840/story.html
B.C. man declared too healthy for alternative to open-heart surgery
By Susan Lazaruk, The Province January 21, 2014
A Nelson man in need of heart surgery says it’s unfair that he has to undergo an “aggressive” open-heart operation instead of a newer, costlier, less-invasive procedure because he’s young and healthy.
Dan Sammartino, 51, needs a new heart valve because of a defect he was born with, but is being denied the more modern method because he’s a good candidate for open-heart surgery.
The St. Paul’s Hospital doctor who pioneered the newer procedure, in which the heart is accessed remotely through a leg artery, is reserved for patients too frail or elderly to survive open-heart surgery because “it’s more cost-effective” for them but less cost-effective for younger, healthier patients.
It’s an example of decisions that have to be made in health care and will become increasingly common with the development of expensive cutting-edge procedures that may not be essential, according to a University of B.C. medical ethicist.
Is it unethical for health-care professionals to withhold a more humane procedure in an effort to control the costs of public health, to better use those savings to help more people?
Biomedical ethicist Michael Burgess, at the School of Population and Public Health, said it depends on which side of the fence you sit.
“If it’s me, I want compassion; if it’s not me, I want justice,” he said.
Sammartino, born with aortic stenosis, or fused valves, but is otherwise healthy, said he’d prefer not to have open-heart surgery because it’s “so intense. They have to cut you right open along the breastbone, and it takes longer to heal. (With the newer procedure), after one day in the hospital, you’re good to go.”
Sammartino, a father of five, aged 20 to seven, one who’s in university and four of whom live at home, said his job managing a bowling alley for a non-profit group doesn’t provide health insurance.
“To be off work for six months (to recover), what would that do to my family?” he asked.
Doctors say the recovery time for open-heart surgery is three months.
But Sammartino fears it could last longer because he knows of a healthy 33-year-old, open-heart patient who is using a walker eight months later, and he estimated he could lose $50,000.
There isn’t enough evidence to determine whether a trans-catheter aortic-valve implantation, or TAVI, is viable over the long-term, said Dr. John Webb, whose procedure revolutionized valve replacement in 2005 and is being taught around the world.
“In the past, there have been valves that haven’t worked,” said Webb.
The average patient age for a TAVI is 84, someone who is “likely to benefit from TAVI for at least two years,” David Babiuk, head of Cardiac Services B.C., said in an email.
Tests on lower-risk patients are being done, he said.
But Sammartino is accusing the B.C. government of “dragging its feet” on those tests and said it’s an excuse to save money.
TAVI valves are $20,000 more than conventional valves. Open-heart surgery patients usually spend more time in hospital, but if they’re younger, those extra costs wouldn’t likely surpass the difference in the costs of the valves, Webb said.
Therefore, “it’s not cost-effective for those who are good candidates for open-heart surgery,” he said. “It (the cost) certainly is a consideration.”
B.C. Health Ministry spokeswoman Kristy Anderson wouldn’t comment on whether the decision on which surgery is done had financial considerations.
“The standard for fairly young, healthy patients requiring a heart-valve transplant is open-heart surgery,” she said in an emailed response.
But Burgess said costs are a factor in health-care decisions, when half of our tax dollars go to health care.
“We can’t afford to help everyone have everything they need,” citing the example of exemptions from Medicare, including glasses and non-essential and cosmetic procedures. He noted the growth of out-of-pocket expenses and costs paid by private insurance is growing apace with overall health-care costs.
But under Canada’s public health system, as with TAVI, patients aren’t always given the option of choosing a more expensive procedure if they pay for it themselves because that runs counter to universal health care.
Burgess said as a society, “we do have to make these judgments over whether the marginal benefits (of a newer procedure) justify the extra costs” to determine what’s fairer to all people.
Webb said St. Paul’s has done about a thousand TAVI procedures since 2005 and do about five a week, the most in Canada. He estimated it would be another five to 10 years for TAVI to be routine for valve replacements.
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twitter.com/susanlazaruk
© Copyright (c) The Province
http://www.theprovince.com/news/declared+healthy+alternative+open+heart+surgery/9409840/story.html
B.C. man declared too healthy for alternative to open-heart surgery
By Susan Lazaruk, The Province January 21, 2014
A Nelson man in need of heart surgery says it’s unfair that he has to undergo an “aggressive” open-heart operation instead of a newer, costlier, less-invasive procedure because he’s young and healthy.
Dan Sammartino, 51, needs a new heart valve because of a defect he was born with, but is being denied the more modern method because he’s a good candidate for open-heart surgery.
The St. Paul’s Hospital doctor who pioneered the newer procedure, in which the heart is accessed remotely through a leg artery, is reserved for patients too frail or elderly to survive open-heart surgery because “it’s more cost-effective” for them but less cost-effective for younger, healthier patients.
It’s an example of decisions that have to be made in health care and will become increasingly common with the development of expensive cutting-edge procedures that may not be essential, according to a University of B.C. medical ethicist.
Is it unethical for health-care professionals to withhold a more humane procedure in an effort to control the costs of public health, to better use those savings to help more people?
Biomedical ethicist Michael Burgess, at the School of Population and Public Health, said it depends on which side of the fence you sit.
“If it’s me, I want compassion; if it’s not me, I want justice,” he said.
Sammartino, born with aortic stenosis, or fused valves, but is otherwise healthy, said he’d prefer not to have open-heart surgery because it’s “so intense. They have to cut you right open along the breastbone, and it takes longer to heal. (With the newer procedure), after one day in the hospital, you’re good to go.”
Sammartino, a father of five, aged 20 to seven, one who’s in university and four of whom live at home, said his job managing a bowling alley for a non-profit group doesn’t provide health insurance.
“To be off work for six months (to recover), what would that do to my family?” he asked.
Doctors say the recovery time for open-heart surgery is three months.
But Sammartino fears it could last longer because he knows of a healthy 33-year-old, open-heart patient who is using a walker eight months later, and he estimated he could lose $50,000.
There isn’t enough evidence to determine whether a trans-catheter aortic-valve implantation, or TAVI, is viable over the long-term, said Dr. John Webb, whose procedure revolutionized valve replacement in 2005 and is being taught around the world.
“In the past, there have been valves that haven’t worked,” said Webb.
The average patient age for a TAVI is 84, someone who is “likely to benefit from TAVI for at least two years,” David Babiuk, head of Cardiac Services B.C., said in an email.
Tests on lower-risk patients are being done, he said.
But Sammartino is accusing the B.C. government of “dragging its feet” on those tests and said it’s an excuse to save money.
TAVI valves are $20,000 more than conventional valves. Open-heart surgery patients usually spend more time in hospital, but if they’re younger, those extra costs wouldn’t likely surpass the difference in the costs of the valves, Webb said.
Therefore, “it’s not cost-effective for those who are good candidates for open-heart surgery,” he said. “It (the cost) certainly is a consideration.”
B.C. Health Ministry spokeswoman Kristy Anderson wouldn’t comment on whether the decision on which surgery is done had financial considerations.
“The standard for fairly young, healthy patients requiring a heart-valve transplant is open-heart surgery,” she said in an emailed response.
But Burgess said costs are a factor in health-care decisions, when half of our tax dollars go to health care.
“We can’t afford to help everyone have everything they need,” citing the example of exemptions from Medicare, including glasses and non-essential and cosmetic procedures. He noted the growth of out-of-pocket expenses and costs paid by private insurance is growing apace with overall health-care costs.
But under Canada’s public health system, as with TAVI, patients aren’t always given the option of choosing a more expensive procedure if they pay for it themselves because that runs counter to universal health care.
Burgess said as a society, “we do have to make these judgments over whether the marginal benefits (of a newer procedure) justify the extra costs” to determine what’s fairer to all people.
Webb said St. Paul’s has done about a thousand TAVI procedures since 2005 and do about five a week, the most in Canada. He estimated it would be another five to 10 years for TAVI to be routine for valve replacements.
[email protected]
twitter.com/susanlazaruk
© Copyright (c) The Province
