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Demand management in plastic surgery for low priority procedures: the Welsh experience
J E Hunter1, J H E Laing, G Carroll
1Welsh Centre for Burns and Plastic Surgery ABM University NHS Trust, Swansea, Wales SA6 6NL, UK. missjudehunter@doctors.org.uk
Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|December 9, 2009
Summary
Health Commission Wales implemented a plastic surgery referral system in 2004. Revised criteria in 2006 led to more patients being denied funding, especially for body contouring procedures.
Area of Science:
- Health Services Research
- Plastic Surgery
- Health Policy
Background:
- Health Commission Wales manages plastic surgery resources for 2.9 million people.
- A screening process for low-priority plastic surgery referrals was established in 2004.
- Revised clinical inclusion criteria were introduced in 2006 to manage demand.
Purpose of the Study:
- To evaluate the effectiveness of the plastic surgery referral screening process.
- To assess the impact of revised clinical inclusion criteria introduced in 2006.
- To analyze changes in referral numbers and funding approval rates.
Main Methods:
- Analysis of the Case Officer's database for referral data.
- Comparison of referral and disallowance rates before and after the 2006 policy change.
- Examination of specific procedure types, including body contouring/abdominoplasty.
Main Results:
- Over 9,654 referrals were screened since 2004.
- In 2005-6, 32.5% of referrals failed to meet inclusion criteria.
- Post-2006, referral numbers decreased, and 46.6% were declined, with 73.2% of body contouring/abdominoplasty referrals non-compliant.
Conclusions:
- The Welsh model demonstrates efficient demand management for plastic surgery.
- Tighter 2006 guidelines increased funding rejections, particularly for body contouring.
- Challenges persist in defining criteria for post-massive weight-loss surgery, with potential impacts on specialist training.