Spinal Fusion Surgery – Wasteful, Unnecessary and Potentially Harmful

19 February 2018

Spinal fusion surgery has been added to a list of procedures deemed to be wasteful, unnecessary and potentially harmful to patients, in a move which is set to relieve stress on the Australian health care system and save millions annually.

Medical professionals have noted an increase in use of the procedure to treat lower back pain, despite no proof of its effectiveness. Estimates of the cost of such unnecessary procedures have suggested as much as $2.3 billion over the last 10 years.

This comes as Choosing Wisely Australia, a medical profession-led health care initiative, has released five new recommendations regarding pain management. These include advice against referring axial lower lumbar back pain for spinal fusion surgery, avoiding benzodiazepines for lower back pain, and avoiding the prescription of opioids for chronic non-cancer pain without long-term screening and periodic attempts to reduce dosage.

The Insurance Effect

Health insurers have cited spinal fusion surgery as a key reason for increases in insurance premiums over recent years. Insurers suggest that a 20% reduction in the instance of such procedures would result in $60 million in savings per year and a subsequent reduction in costs for members.

Private Healthcare Australia head Dr Rachel David highlighted that “probably only 20 patients out of every 100 who get spinal fusion surgery are helped by it. But it gets a lot of funding through the (Medicare Benefits Schedule) and doctors will just come back and say we don’t know which 20% benefit, so they are continuing to operate on people.” Dr David went on to note the challenges – where the medical evidence concerning patient selection is unclear but the public health system sanctions, and continues to pay, under the existing regulatory scheme.

The Australian Prudential Regulation Authority (APRA) has previously warned of a stressed health insurance system and the negative effects of such on consumers and companies alike.

Coverage rates for Australians with hospital cover have fallen to their lowest since 2011. They currently sit at 45.6% and the reduction in those who choose hospital cover has continued following Health Minister Greg Hunt’s announcement of a package of reforms in October 2017.

More work definitely needs to be done, both to reduce costs and create more and better options for patients and the community.