I read an interesting report earlier this month. The Canadian Institute for Health Information (CIHI) released a report on surgical trends between 1995/1996 and 2005/2006. The report found that, over the decade, there has been a 17% increase in the number of surgeries performed in Canada. This statistic didn't really surprise me in light of the fact that Canada's population has increased by approximately 13% in the past decade. What I did find surprising, however, was the 17% overall increase was attributed to a 31% increase in outpatient day-surgeries and a 17% decrease for inpatient surgeries.

The reduction in inpatient surgeries was also associated with a reduction in the total number of admission days in acute care hospitals from 23.3 million in 1995/1996 to 20.3 million in 2005/2006. This reduction in 3 million hospital admission days occurred in spite of a population increase of almost 4 million people over the same period.

These trends should be notable to plan sponsors for two reasons. First, the expansion of outpatient surgeries represents a shift from heavily invasive to minimally invasive surgical techniques. Many surgeries that once required patients to be fully anesthetized can now be done with laparoscopic techniques that require minimal local freezing. Thus, less convalescence time is required and employees can be back to work faster. Second, the shift to more outpatient surgery may lead to greater pressure on private drug plans to cover drugs usually given in hospital, post-surgery. These could include intravenous antibiotics, narcotic pain relievers (oral or injectable) and clot prevention agents, commonly utilized after hip and knee surgeries.

This shift from inpatient to outpatient management is analogous to the trends in chemotherapy administration that has been largely moved to outpatient clinics. Some of the costs of these therapies are also showing up on private drug plans. Plan sponsors should be aware of how these macro-level trends in healthcare in Canada can impact their bottom line through benefits such as the drug plan. What might seem as a fairly innocuous surgical statistic is likely to continue to have an impact on drug plans moving forward. This is just one of many challenges we see with private plans in Canada, and another reason why active management of drug plans will produce significant returns to Canadian employers in the years ahead.

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