A paper published in the British Medical Journal today challenges the policy of referring patients for certain surgical procedures to hospitals carrying out high volumes of surgery. Dr Muiris Houston, Medical Correspondent, reports.
The Canadian research will add weight to the argument of those opposed to the Hanly model for the reform of health services in the Republic.
Drs David Urbach and Nancy Baxter of the Institute for Clinical Evaluative Services in Toronto examined death rates among 31,632 patients who underwent five separate surgical operations over a five-year period.
They say their findings challenge the policy that patients who need a high-tech procedure travel to hospitals that do a high volume of that procedure (a regionalisation policy). The study found that survival after complex surgery was better not only in hospitals that carry out a large volume of the same procedure, but also in those institutions performing a large volume of any complex procedures.
"Volume-outcome association for complex surgical procedures may be less a reflection of extraordinarily good care in high-volume hospitals than an indication of deficient care in poorly supported small and rural hospitals," the researchers said.
It added that a regionalisation policy "would accomplish little for the many patients admitted to small and rural hospitals, for emergency conditions or medical diagnoses, especially if regionalisation leads to further erosion of resources for managing complex medical problems at these hospitals".
Last weekend, in a major critique of the Hanly report, Dr John Barton, consultant physician at Portiuncula Hospital, Ballinasloe, Co Galway, and health economist Ms Catherine McNamara focused much of their criticism on the assumption that high volume equates with better patient outcome.
These criticisms were rejected by the Minister for Health, Mr Martin, and were the subject of a point-by-point rebuttal by the Department of Health on behalf of the Hanly expert group.