Healthcare spending is at an all-time high. With an expanding and ageing population, increase in chronic diseases, more knowledgeable patients and advancements in healthcare technology – prices are bound to skyrocket. Global healthcare spending is expected to reach a growth rate of 6% a year by 2018. That’s nearly triple the 2.6% growth rate in 20141.

Staggering costs can drastically shrink the number of people that have access to potentially life-saving procedures. Is the healthcare community as efficient as it can be? In this article, we look at the necessity of robots, face masks and caps in the operating theatre.

Surgical conditions make up an estimated 30% of the global burden of disease

Researchers Imperial College discovered that 71 commonly performed procedures have been deemed to make nearly no difference on patients’ well-being – but, almost surely will leave a huge dent in their wallets2. These procedures include an overuse of endoscopes that are unlikely to yield diagnostic results and hernia repairs done on minimally symptomatic patients2. The former costs the National Health Service (NHS) of UK nearly GBP42 million, while the latter amounts to GBP28 million2.

“This provides motivation to identify and reduce the use of healthcare interventions that deliver little benefit and which could be substituted with less costly alternatives without affecting safety, and quality of care,” comment the authors of the study.

Interestingly, the same study proposes that even state-of-the-art robotic surgery may offer next to no advantage compared to keyhole operations. Authors claim that there is no evidence of reduction of surgical site infections when operations are performed by robots, and go so far as to mark them as ‘candidates for disinvestment’2.

Surgical face masks and caps: effective or routine?

Surgical masks and caps do little to prevent surgical site infections.
Surgical masks and caps do little to prevent surgical site infections.

Besides robots, the necessity of a surgical face masks and caps in the operating theatre have been inundated with controversy. Any medical student, nurse and doctor stepping into the operating theatre have been trained to reflexively reach for the mask box and to cover their heads in fragile caps. Are these dollars that we could be saving?

While face masks were initially thought to protect the patient from surgical site infections, this assumption has little evidence to back it up3. The same can be said for caps, with reviews declaring that surgical site infection outbreaks could be traced back to hair or scalp microbes regardless of whether a cap was worn4.

Furthermore, it has been argued that face masks may be more important as a means of protection of the wearer. Despite this, it is known that simple face masks may not even offer adequate protection against airborne infections3.

“Lack of evidence of benefit does not equate to evidence of lack of benefit”

Aside from the real value of face masks in the context of immunocompromised patients, there is a scarcity of evidence on both sides of the argument3. The medical community appears reluctant to loosen its grip on caps and masks, arguing that a “lack of evidence of benefit does not equate to evidence of lack of benefit3. In other words, it looks like masks and caps are here to stay – “just in case”. Nevertheless, this is a sign that we could be doing something better – perhaps, by investing money in more efficient protective gears.

While the NHS may be looking for corners to cut, a patients’ group has voiced concerns that these cutbacks may unintentionally hurt those who need it the most2.

“Any changes must be undertaken with the full involvement of patients, and without accidentally limiting access to effective treatments that meet patients' needs,” emphasises Rachel Power, Chief Executive of the Patients Association in the UK2.

Increased healthcare spending is not necessarily a bad thing, as it may signal positive developments such as more efficient treatments and cures. Nonetheless, as healthcare expenditure grows, the pressure to remain efficient and decrease costs can only intensify. It is in everyone’s best interest that the healthcare community stands ready to embrace reforms while shedding obsolete practices. MIMS

Read more:
Calling a spade, a spade: The use of subtle language – and how it affects patients' and public perception
Malaysia's MOH says health spending per person has doubled in 17 years
Turning humble medical scrubs into modern fashion apparel
Hand hygiene: What if HCPs did not wash hands?

Sources:
1. https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-2016-health-care-outlook.pdf
2. http://www.telegraph.co.uk/science/2017/11/08/useless-surgical-masks-robots-could-scrapped-help-save-nhs-150/
3. https://www.academia.edu/1822385/The_effectiveness_of_surgical_face_masks_what_the_literature_shows
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812878/
5. https://www.nursingtimes.net/clinical-archive/infection-control/the-effectiveness-of-surgical-face-masks-what-the-literature-shows/205272.article