According to the Toronto Star, the Drummond Commission will recommend a major overhaul of our health care system, including delisting of certain procedures from OHIP coverage while reducing the incidence of others.
This is a turnaround from Drummond’s earlier insistence that he wasn’t for U.S.-style privatization. If a service is delisted from OHIP, it becomes totally privatized.
There will likely be considerable debate over these procedures, given it is economist Don Drummond, and not the Ontario Medical Association, that is deciding which have value, and which don’t. And just because it is not covered, that doesn’t mean a procedure won’t be performed if someone has sufficient cash to make it happen.
Among the most controversial will be Drummond’s recommendation that fewer Cesarean-Sections be performed in Ontario.
Throughout much of the world delivery by C-Section has been on the rise. In Ontario about one in four births are delivered by C-Section, about one in three in the United States. Ontario is only a percentage point above the national average. More than 80 per cent of women who have already had one C-Section will have another. Only 1 to 2 per cent of mothers actually elect to have a C-section.
No doubt Drummond was looking at a 2010 World Health Organization paper that suggested countries below 10 per cent were likely not performing enough C-Sections, while those over 15 per cent were overusing the procedure. The WHO paper suggests 3.18 million additional C-Sections were needed globally while 6.2 million were unnecessarily performed. The cost of global “excess” according to the WHO was $2.32 billion U.S. – resources they say could be better applied elsewhere.
The WHO has since withdrawn any recommendation on optimal percentages of C-Sections claiming there was no empirical evidence to suggest a number. Further, the data in which the study is based upon has been called into question. It all makes us wonder what Don Drummond would be relying upon as a target?
Dr. Amy Tuteur, a Harvard educated obstetrician gynaecologist, says the rise in frequency may be due to legal reasons. Of the nine most common reasons for obstetric malpractice suits, six allege failure to perform a C-section or failure to perform a C-section sooner.
Nobody seems to have a definitive answer to the rise in C-Sections, but others have speculated it may be connected to the decision by mothers to have their children much later in life. Some have suggested that it may be due to improvements in technology to detect when a mother and/or fetus are placed at risk. Others have suggested that in some countries it is far more lucrative for the health care provider to perform a C-Section than natural birth.
Given most C-Sections in Ontario are performed to protect the health of the mother and/or baby, just what would a government intervention look like? Or will the idea that a necessary C-Section may be withheld prompt at-risk mothers to seek private care?