pkern@csri.toronto.edu (pkern) (02/14/88)
Can a first trimester abortion be condsidered to have the same complexity as the removal of an appendix? Does BC's health care system pay for appendectomies on demand?
doug@edson.UUCP (Doug Konrad) (02/15/88)
In article <1988Feb14.082220.4283@jarvis.csri.toronto.edu>, pkern@csri.toronto.edu (pkern) writes: > > Can a first trimester abortion be condsidered to have the same complexity as > the removal of an appendix? > Does BC's health care system pay for appendectomies on demand? No, it doesn't. And I doubt any other health care plan will pay for an appendectomy on demand either. They don't pay for cosmetic surgery (i.e. facelifts) - only those procedures where the health of the patient is threatened.
clewis@spectrix.UUCP (Chris R. Lewis) (02/20/88)
In article <1988Feb14.082220.4283@jarvis.csri.toronto.edu> pkern@csri.toronto.edu (pkern) writes: > >Can a first trimester abortion be condsidered to have the same complexity as >the removal of an appendix? If there's no complications, it's *MUCH* simpler than an appendectomy. >Does BC's health care system pay for appendectomies on demand? If BC's claims processing system is anything similar to OHIP's, it doesn't know whether it's "demand". All they know is patient ids, doctor ids, dates, diagnosis codes, service codes. Unless they differentiated the service codes to something like "medically necessary" versus "unneccessary". If we ignore abortions for a moment, the "rub" with respect to the "demand" question is entirely the physician's responsibility. A Physician's ethics include something that basically means "don't do anything that's not medically necessary". [Sorry, I don't have an exact quote, nor am I sure whether it's part of the "Greek" ethics or the "modern" ethics (I think you get to choose which one you swear...). It may simply be an outgrowth of "do no harm".] Therefore, a physician is usually prohibited by his own ethics from performing a procedure that isn't medically necessary (eg: "Wouldn't it be neat to have my appendix out for the heck of it?"). Once the physician has made that decision that it's medically necessary, he can then do it and the claim form goes into the claims processing dept. (CPD) All the CPD knows is "diagnosis code" and "service code". There is a "diagnosis code" of "no illness". This is primarily used for diagnostic procedures (lab tests etc). Generally speaking a MD might have the Medical Review Comittee (MRC) of the College of Physicians and Surgeons jump on him if he said "no illness" and "removed appendix". (Sounds like malpractise doesn't it?) This starts getting pretty sticky when you get to some forms of voluntary services, eg: plastic surgery. Generally speaking, the provincial health insurance systems use a *very* narrow definition of "medical necessity". Usually: Some "physical harm" will result if the service is not performed or: Some "physical benefit" will result if the service is performed. The health insurance systems aren't very good at considering "psychological harm" - eg: self-image and confidence improvements after reconstructive plastic surgery. Which is why few provinces will pay for plastic surgery, no matter what the root cause was (trauma, birth defect, or simple yearly "remodelling"). Physicians are simply more likely to consider the "whole picture" - physical, social and psychological. What makes things worse in the case of abortion (disregarding the moral issues of abortion itself) is that pregnancy *isn't* a disease or abnormality. At least the physicians and Health Insurance Plans officially think that way (thank god). [Disregard for the moment that the mid-wifery and natural birth (and others) lobby claims that the medical system treats pregnancy as a disease that requires considerable intervention - it's irrelevant here] So, therefore, by both the physicians ethics and the Insurance Plans policies, an abortion during a "normal" pregnancy is never medically necessary (as in "abortion on demand"). So, abortion on demand tromps on both the Health Insurance policies AND medical ethics. As does appendectomy on demand, plastic surgery on demand etc. As we should EXPECT damnit! What is happening is the following: 1) Physicians are at least attempting to take a broader view of "medicial necessity" of abortion versus continuation of a pregnancy. And are taking into account psychological, social and economic issues. As they do in many other procedures (eg: plastic surgery) 2) Governments are keeping to their age-old policies w.r.t. "medical necessity". It takes forever for anything to be formally "fixed" in the provincial regulations. 3) The Federal Government is *intentionally* leaving the whole issue vague in the legislation. They simply won't get off the fence and declare themselves one way or another. With the legislation the way it is now they can say they're on either side of the fence depending on which way the wind is blowing in front of the reporter's microphone. 4) The various groups (women's rights, right-to-life, government, media, chauvinist pigs etc) generally either don't know, couldn't care, explicitly ignore, categorically deny that such a distinction *could* exist regarding medical necessity. They all want to make political points about their own particular bee in their bonnet and nobody really cares what the issue *really* is, what anybody else says, or what the public *really* thinks. Frankly, if we could have for once and for all some an answer to the "NEVER" versus "SOMETIMES" versus "ALWAYS" question of whether abortions are permissible, I think we could finish this issue for once and for all, and that (surprise!) the medical profession's ethics would actually work. (That Greek guy really did a good job.... Wish *my* programming lasted that long :-) So, why in hell don't we have a referendum? [Incidentally, my own personal position is that abortion should be permissible (and reimbursed by the provincial health plans) on a basis of medical necessity, where medical necessity *MUST* take into account more than just the physical aspects of a specific case. Psychological and social issues should be part of the decision process. As it usually is with ANY other medical procedure. And frankly, in most cases I believe that a physician will give a correct decision. Though, to save ourselves from individual cranks I do like the suggestion that a second MD's opinion should be required. Infinitely better than Abortion Committees where half the time they seem to be packed with special interest groups that say "NO" or "YES" 100% of the time. And we don't HAVE to force any particular practitioner to participate in an abortion against his/her own convictions. I'd just like to avoid abortions where the reasons are frivolous or simple inconvenience.] -- Chris Lewis, Spectrix Microsystems Inc, UUCP: {uunet!mnetor, utcsri!utzoo, lsuc, yunexus}!spectrix!clewis Phone: (416)-474-1955