Weight-loss surgery 'very underfunded'

Mark Smith.
Mark Smith.
About 80% of the South Island patients who need weight-loss surgery are being turned away because of funding constraints, says the Invercargill surgeon who performs half of the South Island's public weight-loss operations.

Mark Smith, who trained in the United States in the life-changing procedure, is one of three South Island bariatric surgeons.

The other two are in Christchurch.

He performs 24 public operations a year, and about the same number again in private practice.

The number of procedures had increased in the past year, but it was still far too low.

The South Island is allocated 48 bariatric operations a year, meaning some 80% of patients who meet the criteria are missing out.

In July, the South Island became a single bariatric service, meaning one waiting list, and closer relationships between Mr Smith and the two Christchurch surgeons.

''I'm passionate about bariatric surgery ... I really enjoy working with these patients and enjoy the effect it has on people's lives.

''The most frustrating thing is telling people that yes, they would benefit from surgery, but no, we can't offer it to them,'' Mr Smith said.

The high approval threshold effectively meant those who got surgery were unwell, typically with diabetes, and also other conditions.

It was gratifying to help alleviate medical problems caused by excess weight, but the surgery should also be available to prevent illness from developing, particularly in younger patients, he said.

New Zealand performed far less weight-loss surgery (public and private) per head of population than Australia.

It was easier for insurance companies to decline cover for weight-loss surgery in New Zealand, partly because of comparatively weaker regulation, he said.

''It would be nice if they did, but they don't really have a financial incentive to in New Zealand.''

In the United States, companies had an incentive because insurance covered all aspects of healthcare, including diseases such as diabetes, while other countries regulated to prevent them opting out of cover.

The service was in a good position to lobby the Ministry of Health for more funding.

As a South Island service, it could prove access to surgery was consistent, because of the single waiting list.

To qualify for a public operation, patients needed a body mass index more than 40; must have been overweight at least five years, and have tried to lose weight by other means for two years.

Even meeting those criteria, only about one in five was accepted in the ''very under-funded service'', he said.

Privately, the procedures cost between $20,000 and $24,000, depending in part on the type of bariatric surgery performed. Procedure types included gastric bypass and laparoscopic sleeve gastrectomy.

Ministry of Health electives and national services DHB performance manager Clare Perry said in an email at least 480 bariatric procedures would be carried out over the next four years (starting 2014-15), helped in part by a government funding boost earlier this year.

This was in addition to the bariatric procedures carried out as part of the normal range of DHBs' elective surgery.

Historically, Counties Manukau DHB had carried out more bariatric surgery than other areas.

''This has, and continues, to underpin, the higher number of bariatric surgery procedures in the North Island,'' she said.

 


Bariatric surgery
(Weight-loss surgery)

• Cures established morbid obesity.

• Frequently cures type 2 diabetes and other medical problems.

• About four out of five patients referred in South Island declined (public sector).

• Since July, a South Island-wide service, meaning one waiting list.

• NZ performs about half of the procedures per head of population compared with Australia (public and private).


 

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