What should the public health system fund?

Stuff reports:

The letter comes after Christchurch weight loss blogger Elora Harre, posted on her Facebook page, the Shrinking Violet, that she had been refused excess skin removal surgery during a consultation with a plastic surgeon at Christchurch Hospital on Friday.

She was told she was a “perfect candidate” but the hospital lacked resources to operate, she said.

“Why is it that despite the fact we are quickly becoming an obese nation, for someone who has done what I was asked and lost the weight that could’ve cost our public system A LOT more, that there is no resource for me?” she wrote.

She said the excess skin on her stomach, inner thighs, calves, lower back, arms, breasts and armpits caused her both psychological discomfort and physical discomfort, including a recurrent staph infection in her navel.

The post, which has attracted more than 600 “likes”, called on her thousands of followers to email Christchurch hospital general manager Pauline Clark and Minister of Health Jonathan Coleman in support of her cause.

I have some sympathy for Ms Harre’s cause. By losing weight naturally she has saved the health system money, and specifically could have been eligible for gastric bypass surgery which is very costly. It would arguably be a nice incentive that if you lose weight without surgery, you could qualify for some cheaper cosmetic surgery to remove excess skin.

However with limited resources it is hard to argue it is a priority:

Christchurch Hospital’s clinical director of plastic surgery has responded to criticism from a woman who was refused excess skin removal following her 55-kilogram weight loss.

In a letter to Stuff.co.nz, Dr Barnaby Nye wrote of the challenge of delivering health care in a budget-constrained environment. …

In his letter, Nye did not wish to comment on individual cases, but offered hypothetical case studies of patients he may treat, including a woman with carpel tunnel syndrome, and a man requiring jaw reconstruction after cancer removal.

“Every one of these patients lives will be improved with surgery,” Nye wrote.

“We are tasked with drawing a threshold to treat patients in the public system and must weigh the benefits for each of these … Our budget demands a certain number of cases be done per year but with limited operating time, operating on [one person] potentially denies more than 30 [other people] the chance of treatment.”

It is hard to say that the clinicians have their priorities wrong.

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