Helping People Lose Weight Via Traditional & Surgery Alternatives
British Columbia – Wait Times, Facts, Costs & Other Nonsense
Author
Ron Merk
There are just over 4 million citizens of our great province of British Columbia (per 2006 numbers)
19% or 760,000 of us are not just over weight, but are considered obese – >30 BMI
An average of $1400 (US) or $1700 (CDN) additional health care dollars are spent yearly on doctors, prescriptions and other medical procedures for each person classed obese (per latest CDC numbers from the US -I actually suspect Canada spends more because we have a Health Care System that is more accessible) This does not included lost time and productivity dollars. Just in medical costs, that’s a total of $1,292,000,000 for BC.
Average BC Medical Costs
- Normal Weight = $3600 yearly
- Obese = $3600+$1700=$5300 yearly
Gastric/Bariatric surgery cost approximately $15,000
BC completed 111 bariatric surgeries in 2008
There are approximately 650 people currently waiting for gastric/bariatric surgery in BC. Assuming some drop off the list and some come on, the current wait for surgery will be approximately 3 to 5 years – unless you choose Banding and pay for it yourself. Contrary to popular belief on how long you’ll have to wait for surgery isn’t associated to what surgeon you go to. Surgery rooms/hours are allocated by the Regional Health Board. VIHA does 95% of the gastric/bariatric surgeries in BC.
Average life expectancy in BC is 79. Conservative estimates indicate life span for people with BMI’s >30 are shortened by a least 5 years. (so far we’re just talking numbers …and haven’t touched on quality of life!)
Let look at a hypothetical business case for bariatric surgery:
Save it Now or Spend it Later
Break even point on Return of Investment = 8.8 years (Cost of surgery $15K / Additional Yearly Med Costs $1.7K). Now an ROI of 8.8 years isn’t the best from strictly a business perspective. Most profit oriented businesses want investment returns under 5 years. Being as this isn’t about profit and more about cost avoidance we should look at it from a NPV (Net Present Value) perspective over 25 years. Here’s what that looks like:
Over 25 Years NPV (cost of money 6%)
No Surgery = ($22,105)
With Surgery = $6,351
That’s a cost avoidance total per person over 25 years of approx $28K
Multiply that by 650 people on the wait list = $1.8 million dollars
If we increased our foot print in aggressively treating obesity via bariatric surgery for BC citizens to say a conservative 20% of the 750,000 who we know are already obese, than BC would have a cost avoidance over 25 years of $4,200,000,000.Remember! This was calculated over 25 years. Most of us after surgery will live closer to our BC average life span of 79, which would only make this cost avoidance number MUCH larger.
Now we haven’t even talked about pain, suffering and quality of life yet, but I have to say …it seems like a really big number with a lot of zeros behind it. Surely someone, somewhere in the halls of power would want to save tax payers that kind of money??
OK … may be I’m just having a moment of nonsense. I’ll try and get back on side with all the executives at VIHA, MOH and our political representatives. I promise to just whine and not mention the money facts. The number is too big anyway and would just confuse most of them. It certainly confuses me!
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14 Comments
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Hi Ron i see you,ve Got The costs figured out and i agree 100 %. To bad they,the govt. can,t I guess all we can hope for is that they will wake up and smell the roses Robert.
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I see you managed to come up with a great topic as usual keep up the great work I really enjoy your articles
Darlene
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Hello Ron
Thank you for this website and the great information you are sharing.I am a post weight loss and reconstructive surgery patient as well as a social work student who wants to advocate for a Bariatric Centre of Excellence on Vancouver Island similiar to the initiative recently announced in Ontario.
I am trying to understand how our wait list works in BC. Here’s what I understand so far.
1. The health authority (VIHA on the Island) allocates surgery time to each surgeon.
2. The surgeon takes their allocated time and prioritizes the patients as urgent, semi-urgent, or elective.
3. Bariatric surgery is classified as general surgery.
4. BC has a Wait Times Strategy but as far as I can see there is a narrow focus. “BC’s Provincial Wait Times Strategy to clear backlogs and improve access, which is aligned with priority areas identified in the First Ministers’ Meeting 10-Year Plan to Strengthen Health Care—hip and knee, sight restoration, cardiac, cancer and diagnostic imaging—and best practice nationally and internationally” (http://74.125.155.132/search?q=cache:SWBV2x_GPKkJ:www.health.gov.bc.ca/library/publications/year/2009/Access_to_surgery_SAC_Final_Report.pdf+bariatric+surgery+rules+bc&cd=7&hl=en&ct=clnk&gl=ca).My questions are- how many WLS surgeons are active in BC?
Is there a government criterion for establishing what is urgent, semi urgent, and elective?
Under what circumstances is a client sent out of province or country and still be covered under MSP?
Is there a provincial cource that could confirm the ansers to these questions?Thank you
Bonnie -
Hi Bonnie:
I’m liking the responses to this article …so far it’s generating more comments than all the other articles on the site
In response to your questions:
1. My questions are- how many WLS surgeons are active in BC? As far as I know …3, all in Victoria. There may be 1 or 2 others in Vancouver or Kelowna who have done occasional Lap Bands …but doesn’t happen often, because the other regional Health Authorities see the surgery is elective and the surgeons don’t do enough to feel comfortable doing the surgery once in a while.
2.Is there a government criterion for establishing what is urgent, semi urgent, and elective? WLS is classified as “ELECTIVE” General surgery. That means it always comes last
3. Under what circumstances is a client sent out of province or country and still be covered under MSP? Every individual must apply to the MOH. Each is accessed on it’s own merits. (who knows how they choose?) Latest I heard is it was costing too much so the MOH staff have been told to tighten the approval criteria. (in other words ..don’t approve any)
4. The VIHA and MOH web sites are the only sources I know of other than writing specific questions to them and getting an answer back that is couched in real info rather than political jargon.. You can try:
VIHA – http://www.viha.ca/
MOH – http://www.gov.bc.ca/health/
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Hi ron,I awaiting my 1st appointment with dr amson,for biartic surgery,I am 54 and have diabetese,am disabled have heart disease,my docttor told me I need the surgery too take the weight off of my feet,ease the strain on my bad back and to lessen the risk of another heart attack,,do these issues move me up on the wat list for the surgery? thanks ron
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Hi Jim:
The real question you need the answer to, is – How many other people have worse medical challenges to you?. Dr Amson (and all the surgeons) prioritize surgery based on your condition, chance of success related to all the others on the list.
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Hi Ron
Very good article. I have only one comment to make on your reply to Bonnie.3. Under what circumstances is a client sent Out of Province or Country (OCC) and still be covered under MSP? Every individual must apply to the MOH. Each is accessed on it’s own merits. (who knows how they choose?) Latest I heard is it was costing too much so the MOH staff have been told to tighten the approval criteria. (in other words ..don’t approve any)
I have gone this route myself and just received approval on August 14th. I know of at least one more person who was also approved in August. After spending 2 years on wait lists in BC I found out about OCC funding in May of this years. From what I have been lead to understand the criteria is: BMI 50+ and at least 2 co-morbidities. I had a BMI or 57 when I started the approval process (I have since managed to lose 66 lbs) plus OSA, hypertension with severe pitting oedema in my legs which lead to MSRA infection in my leg calf last winter. The entire process from learning about the possibility of OCC funding to my surgery date is just under 6 months. and has/will cost me, $200 to have my application filled out by a surgeon, 3 car trips to and from Seattle, $300 CDN to talk to a psychologist in Seattle (required) and a hotel room for 3-5 nights for my support person. When put in perspective the hotel stay would be the same whether I had my surgery in Victoria or Seattle, and I would have to make 6 or so trips to Victoria at more than $100 each time for the ferry. So really going to Seattle is cheaper for me in the long term. If anyone is interested in any info they can contact me at l.sterne@shaw.ca
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Great info for everyone to have re OCC – 50+ BMI and at least 2 co-morbidities clarifies how likely some one is to receive approval. I also agree with your perspective on direction that MOH staff have received regarding approving OCC requests. It would be interesting to know how many outstanding request are sitting with the MOH and what their approval rate is.
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I have no idea how many are sitting but I had a 15 day turn around to my decision which tells me that they make their decision really quickly, and that they have a set criteria. There is a also singleperson in charge of the WLS requests also which helps streamline things I am sure.
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You don’t happen to know the contact name and info of the MOH “single” person in charge of WLS requests?
One thought that has crossed my mind is that every single person that is on the wait list should fill out an “Out of County” request as soon as they have their first consult with their surgeon.
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Dr Amson & cut backs
Well were do I start……DISAPPOINTED, FEEL BETRAYED FOR SURE!
I really thought and prayed that Dr Amson was telling me the absolute truth when he told me I would be waiting 1yr or less for the sleeve.
After reading about the recent cutbacks……I now realize I will be waiting up to 5yrs….
IM SAD!I was borderline diabetic….but this past year I have managed it….no longer borderline!
I have carefully watched my blood pressure…..normal to dayMy BMI- 42.5
Been over weight for over 20yrs……Im 50yrs old now
I have managed to go from 230-227……
I have osteoarthritis in my knees and back…..have had one knee surgery and have a hell of time walking
I try to stay postive and fight through the pain, staying active is helping me keep the weight maintained but it wont come off….when it does it quickly re-appears!
I work a physical job full time…and collapse when I get home.
I know feel I must EAT my words and apply to go to the states….in 5 yrs time I will be 55…I want my life back now!
I havent done much research about the states, as I told myself I would never ever ever go…….do they do the sleeve?
I would rather stay a patient of Dr Amsons but, I now realize he will choose others who have been waiting longer then me…..and I wont see an OR room for 5yrs!!!!
Golly…..Ive managed to fight though bouts of despression……THESE CUT BACKS MAKE ME DEPRESSED !!!!
awating the sleeve
Penny Smith
Kelowna BC -
Penny I know exactly how you’re feeling, Keep your chin up girl!… However that being said, Remember that there are ALWAYS people who are worse off than us.. I feel the same way about “Wanting my life back NOW” I am only 23 years old and I literally don’t have a life, I can’t do a whole lot because my weight stops me from almost EVERYTHING!! I had to turn down a job last week because I am not able to physically keep up,… I am 5’2″ & my BMI is 74!!!!!!!! Anyways enough of me complaining, Just always remember when your feeling down, It really could be WORSE!! Stay positive
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words of encouragement paigebear…..wishing you nothing but success and happiness
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The wait times are discouraging indeed, and I fully agree with the perspectives published regarding the long term financial benefits to the provincial health care system of funding WLS. Unfortnately, politicians on all sides of the political spectrum tend to think more in terms of shorter term gains. This is not because they are inherently bad people, but because to get (and keep) their jobs, they need to think in terms of election cycles, and what will make them look like successful leaders in they eyes of the average voter. I speak from experience on this – while I don’t work for the BC Minisry of Health, I am a bureaucrat employed in another government agency.
So what does that mean for WLS advocates? I would suggest that some strategies presenting potential shorter term wins are going to be essential. While they may not solve the whole problem, they could at least raise the political consciousness of WLS to a higher degree, and (over the longer term) creating more openness to full public funding of bariatric surgery.
What might a shorter term win look like? Our Provincial government has made many statements about the importance of creating healthy communities and healthy citizens; but it has also inferred that personal responsibility needs to be part of the equation. An avenue for increasing provincial funding for WLS while linking it to the personal responsibility component might exist around the gastric banding option.
As we all know, banding surgery receives no funding at all in the provincial system. At present the only way to recoup a minor portion of the costs for banding is through a small income tax refund which comes nowhere near covering full costs. But what if we started asking the Province to pass a special refund rogram for banding surgery, linked to patient performance (documented with a doctor’s letter)? For example, the refund could be given out over a five year period, and subject to medically sound criteria. So assuming a roughly $15,000 cost for the surgery, you would get an automatic $3,000 refund for just having the surgery. Then for the next $3,000 you would need a signed doctor’s letter saying that you had achieved and maintained at least 20% of your overall target weight loss by your year one anniversary date. In the next year this would be bumped up to 40%, etc until potentially the full amount had been reimbursed. While this idea still has costs for the patient, it could potentially reduce at least the number of middle and upper income British Columbians currenly on the waiting list for gastric bypass surgery. This could then free up the room for people whose incomes would preclude any form of self-pay option.
To put things in perspective, I did pay the money for banding myself. We didn’t have the cash lying around – we added the amount to our mortgage, so effectively borrowed the money. I just decided that it was time to invest in myself. I am fully aware that this option is not possible for everyone -and in cases of extreme obesity, holding down a job can be difficult, if not impossible. Anyway, these are just my thoughts…
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