The non-medical surgical assistant and inequity in the Australian healthcare system

Objectives: The objective of this discussion paper is two-fold. The first is to quantify if the non-medical surgical assistant increases access to surgery by investigating what percentages of cases these clinicians undertake in the private sector surgical units where they work. The second is to examine procedural and distributive justice and how they impact on private sector surgical care. Aim: The aim of this paper is to investigate if the non-medical surgical assistant increases equity via access, for the patient, to private sector surgical care; and if government policy has an impact on equity in the form of access. Background: The private healthcare sector completes approximately two-thirds of all elective surgery in Australia; without this contribution, there would be more pressure on the public healthcare sector. In the private sector, recognition and federal funding of the surgical assistant differs depending on whether this clinician has a medical or non-medical, eg. nursing, qualification. The role of the non-medical surgical assistant is well established internationally and this role has been practiced in Australia for more than 20 years. Discussion: Inequity; as a result of the procedural injustice of government funding policy, impacts the private sector surgical patient causing distributive injustice. This distributive injustice results in an out-of-pocket expense to the patient. Rising outof-pocket expenses has started a trend of patients moving away from private health insurance and into the public sector. The registered nurse and nurse practitioner are qualified to practise as a non-medical surgical assistant and provide increased access to care, and effective care compared to the medical surgical assistant. The nurse practitioner is an eligible provider of Medical Benefits Schedule services but restricted from accessing the intraoperative assisting item numbers. Conclusion: The non-medical surgical assistant; or at least the nurse practitioner as non-medical surgical assistant; require access to the Medical Benefits Schedule intraoperative item numbers. Access would alleviate the out-of-pocket expense incurred by Australian patients when a non-medical surgical assistant assists with their surgery. Lack of access to these item numbers means patients may have their surgery delayed until an appropriately skilled medical surgical assistant is available, or the public healthcare sector can accommodate them. AUTHORS TONI HAINS RN, MClinSc (PNSA), MNPractSt, PhD Cand.1 DAVID ROWELL RN, MHEcon (Advanced), PhD (Econ.)3 HAAKAN STRAND RN, MNPractSt, PhD1,2 1 The University of Queensland, School of Nursing, Midwifery and Social Work, St Lucia, Queensland, Australia. 2 College of Nursing and Midwifery, Charles Darwin University, Casuarina, Northern Territory, Australia. 3 The University of Queensland, Centre for the Business and Economics of Health, Woolloongabba, Queensland, Australia. The non-medical surgical assistant and inequity in the Australian healthcare system CORRESPONDING AUTHOR TONI HAINS School of Nursing, Midwifery and Social Work, Level 3, Chamberlain Building, The University of Queensland, St Lucia QLD 4072. Phone: +61 405 469 463. Email: toni@hains.com.au REVIEWS & DISCUSSION PAPERS 6