The Safety of Outpatient Surgery: Issues Relevant to Our Border Community
The Rio Grande Valley is a unique environment because we have two health care systems regulated by two different sovereign nations within a short distance of each other. The reality is that the cost of undergoing an outpatient surgical procedure, if there no complications, can be much less expensive by as much as 50 percent in Mexico vs. the United States. So the question is it worth it to have surgical procedure in Mexico is raised?
At least 70 percent of all surgeries are now done as outpatient procedures. An outpatient procedure is most simply defined as a procedure, which does not require care in a facility for more than 23 hours. Many procedures like hernias, breast augmentation, cataract removal, and gall bladder removal for example, which were traditionally associated with a hospital stay are now done as outpatient. Technological developments spurred on by the wish of practitioners to reduce risks and improve outcomes for their patients as well as a general need for the society to reduce health care costs have acted in concert to push these changes.
Whether we like to admit it or not, the quality of healthcare and costs of healthcare have been and always will be two issues that can conflict with each other. The reality is that no society will be ever be able to do everything possible for every citizen to have absolutely the best care every second of every day. On the other hand, most civilized countries including the United States, have sought to establish levels of care that would be considered reasonable for its citizens. This is one of the reasons health care providers and facilities are licensed and regulated.
The State of Texas, in addition, to licensing and regulating doctors and nurses, also regulates the licensure of all facilities which perform outpatient surgical procedures. There is an initial inspection done after five procedures are performed and then a repeat inspection every three years. In the interim if a facility has a complication such as a death, a stay more than 23 hours, or has a patient that requires a transfer to a hospital then that must be reported to the state and will be routinely investigated according to Linda Porter of the Texas Medical Board.
The facilities must follow Federal and State guidelines involving their architecture, staffing, record keeping, training, preparation for emergency, and competency. District Manager for Texas Medical Board Licensing Unit, Patrick Waldrin, told Contempo that the overall record of outpatient surgery centers in the Rio Grande Valley was excellent. He estimated compliance with standards in the program to be above 99 percent.
So at least for the United States side there exists a system of safeguards to protect patients against facilities that repeatedly cause injury or fall below acceptable standards. This issue however is not so clear as regards Mexico.
The World Health Organization in it’s 2007 report had this to say :
“Mexican health care system however suffers from some of the typical problems and challenges afflicting similar systems in other developing countries. For instance, there is governmental funding and subsidized health care facilities for the poor. Moreover,
there are hospitals run by government agencies. But the problem lies in the fact that many of these establishments are not properly managed and lack adequate facilities. Also, like in most other developing countries, there is a common belief, though not always correct, that a government-run health care system is inferior to that in the private sector. The rich and the more economically well-off sections of the population therefore increasingly resort to private clinics and private practitioners with many affluent Mexicans often traveling abroad for medical treatment especially the United States.”
The Organization of Economic and Co-operation Development for Mexico said this in its most recent report: “There is a significant variability of care in different institutions. Throughout the system there is a generalized lack of pharmaceuticals. There is a lack of adequate government funding with out of pocket expenses exceeding 42% of costs.”
Trying to find statistics on healthcare in Mexico is very difficult. The national government runs a “national health information system” which it pictorially shows as many circles and arrows point ing to each other and no one in charge.
As best as I can determine their goal is to look at overall societal statistics such as pre-mature infant mortality, mal nutrition, and life expectancy. They do not have independent inspectors that go out and collect data but rather depend to a large extent on the voluntary reporting of health care statistics from the private sector.
This is the crux of the issue. I know from my experience that there are many great and gifted Mexican surgeons who practice in excellent facilities but how does one know who they are? Certainly there is no reliable independent government body currently regulating them.
As a retired surgeon, I am very concerned about the potential for complications and their outcomes. Even the best surgeons will have rare complications, which are potentially life threatening. Whether a patient lives or dies may depend upon the skill of an anesthesia practitioner in his ability to get air into patient’s lungs in less than a few moments. An expected cardiac event or bleeding that requires emergency transfer to a modern well-equipped hospital, which can handle it, is going to have a better outcome on this side of the border.