The non-medical surgical assistant and inequity in the Australian healthcare system

Abstract

Objectives:The objective of this discussion paper is two-fold. The first is to quantify if the non-medical surgical assistant increases access to surgery by investigating what percentages of cases these clinicians undertake in the private sector surgical units where they work. The second is to examine procedural and distributive justice and how they impact on private sector surgical care. Aim:The aim of this paper is to investigate if the non-medical surgical assistant increases equity via access, for the patient, to private sector surgical care; and if government policy has an impact on equity in the form of access. Background:The private healthcare sector completes approximately two-thirds of all elective surgery in Australia; without this contribution, there would be more pressure on the public healthcare sector. In the private sector, recognition and federal funding of the surgical assistant differs depending on whether this clinician has a medical or non-medical, eg. nursing, qualification. The role of the non-medical surgical assistant is well established internationally and this role has been practiced in Australia for more than 20 years. Discussion: Inequity; as a result of the procedural injustice of government funding policy, impacts the private sector surgical patient causing distributive injustice. This distributive injustice results in an out-of-pocket expense to the patient. Rising outof-pocket expenses has started a trend of patients moving away from private health insurance and into the public sector. The registered nurse and nurse practitioner are qualified to practise as a non-medical surgical assistant and provide increased access to care, and effective care compared to the medical surgical assistant. The nurse practitioner is an eligible provider of Medical Benefits Schedule services but restricted from accessing the intraoperative assisting item numbers. Conclusion:The non-medical surgical assistant; or at least the nurse practitioner as non-medical surgical assistant; require access to the Medical Benefits Schedule intraoperative item numbers. Access would alleviate the out-of-pocket expense incurred by Australian patients when a non-medical surgical assistant assists with their surgery. Lack of access to these item numbers means patients may have their surgery delayed until an appropriately skilled medical surgical assistant is available, or the public healthcare sector can accommodate them.

Effectiveness of the Non‐Medical Surgical Assistant measured by patient outcome assessment

“…Along with this research that considered effectiveness, the Donabedian pillars of legitimacy and equity have been investigated in the context of the Australian NMSA (Hains et al, 2020; Hains, Turner, & Strand, 2018a). Further research is recommended to investigate the pillars of efficiency and optimality, which examine quality as a measure of cost and benefits of the role of the NMSA in Australia.…”

“…It is the Australian government's role to deliver high‐quality equitable health care. This concept is elaborated on in Hains, Rowell, Turner, and Strand (2020).…”

Benefits and impacts of the PNSA role: surgeon and nurse perspectives

“…The potential barriers to perioperative nurses becoming PNSAs was explored in the research to identify future potential workforce shortfalls, due to a projected increased demand for surgical services. 23,29 PNSAs contribute to the provision of surgical service delivery in rural public health services, where demonstrated doctor shortages exist and advanced practice nurses are required to meet future service demand. 2,23 With barriers to perioperative nurses pursuing the role of PNSA in Australia; however, and ongoing obstacles relating to professional recognition and accredited remuneration pathways for PNSAs, an expanding PNSA workforce or broader scope of practice for improved surgical patient care is improbable in the imminent future, and a challenge for the distant future.…”

“…28 The PNSA is also perceived to be linked to equity of access to surgery within both the private and public health systems. 29 To further encourage professional recognition of the PNSA role in Australia, it is important to broaden the evidencebase affirming the benefits and contributions of the PNSA role to patient care, the perioperative team and the healthcare setting. This study explores the knowledge, skills and qualities the PNSA role contributes to surgical service delivery in Australia, from the perspective of perioperative nurses and surgeons who work with PNSAs in South Australia.…”