Physician bonuses help drive increases in surgery with minimal patient benefit

Financial incentives for Ontario surgeons are likely a key factor driving greater use of laparoscopic colon cancer surgery, says a study led by a McMaster University surgeon.

The research, published online by the Annals of Surgical Oncology, found that between 2002 and 2009 there was an increase in laparoscopic versus traditional open techniques for colon and rectal cancer surgery. These increases were associated with only minimal decreases in how long patients stayed in hospital after surgery and no changes in the survival of patients.

The authors point out that in October 2005, the Ontario physician billing schedule was altered, providing surgeons with a 25% premium if laparoscopic rather than open techniques were used for . In Ontario, surgeon and hospital services are publically funded and patients don't pay. Most of the incentives went to surgeons already enthusiastic about laparoscopic approaches.

"Our paper highlights two important issues," said principal investigator Dr. Marko Simunovic, an associate professor of surgery of McMaster's Michael G. DeGroote School of Medicine.

"First, in our publicly funded health care system we need to critically review the advantages and disadvantages of new expensive technologies or treatments before they're widely introduced into the province. Second, Ontario physicians provide to the best of their abilities - one should question the logic of financial incentives."

Simunovic added: "A 25% bonus for laparoscopic surgery sends a strong signal to surgeons that they should provide this service, even though the available evidence to date does not demonstrate superiority for laparoscopic versus open techniques."

The more expensive laparoscopic surgery usually results in a smaller and a slightly shorter hospital length of stay.

More information: link.springer.com/article/10.1245%2Fs10434-013-3123-2

add to favorites email to friend print save as pdf

Related Stories

Approach to hysterectomy varies despite advances

Apr 01, 2013

(Medical Xpress)—By age 65, one-third of women in the United States will have a hysterectomy, an operation to remove the uterus. Most women will undergo a traditional abdominal hysterectomy, despite advances in minimally ...

Recommended for you

What are the chances that your dad isn't your dad?

4 hours ago

How confident are you that the man you call dad is really your biological father? If you believe some of the most commonly-quoted figures, you could be forgiven for not being very confident at all. But how ...

New technology that is revealing the science of chewing

Apr 15, 2014

CSIRO's 3D mastication modelling, demonstrated for the first time in Melbourne today, is starting to provide researchers with new understanding of how to reduce salt, sugar and fat in food products, as well ...

After skin cancer, removable model replaces real ear

Apr 11, 2014

(HealthDay)—During his 10-year struggle with basal cell carcinoma, Henry Fiorentini emerged minus his right ear, and minus the hearing that goes with it. The good news: Today, the 56-year-old IT programmer ...

Italy scraps ban on donor-assisted reproduction

Apr 09, 2014

Italy's Constitutional Court on Wednesday struck down a Catholic Church-backed ban against assisted reproduction with sperm or egg donors that has forced thousands of sterile couples to seek help abroad.

User comments