Abstract
BackgroundFoot and ankle problems are highly prevalent in the general community and a substantial proportion of people seek surgical treatment to alleviate foot pain and deformity. However, the epidemiology of foot and ankle surgery has not been examined in detail. Therefore, the aim of this study was to examine patterns and costs of private sector foot surgery provision in Australia.MethodsData pertaining to all foot and ankle surgical procedures for the calendar years 1997–2006 were extracted from the Australian Medicare Benefits Schedule (MBS) database and were cross-tabulated by sex and age. Descriptive analyses were undertaken to assess sex and age differences in the number and type of procedures performed and to assess for temporal trends over the ten year assessment period. The total cost to Medicare of subsiding surgeons' fees in 2006 was also determined.ResultsDuring the 1997–2006 period, 996,477 surgical procedures were performed on the foot and ankle by private surgeons in Australia. Approximately equal numbers of procedures were performed on males (52%) and females (48%). However, males were more likely to undergo toenail, ankle, clubfoot, tarsal coalition and congenital vertical talus surgery, whereas females were more likely to undergo lesser toe, first metatarsophalangeal joint (MPJ), neuroma, heel, rearfoot and lesser MPJ surgery. The total number of procedures was stable over the assessment period, however there was a relative increase in the number of procedures performed on people aged over 55 years. The total contribution of Medicare to subsiding surgeons' fees for procedures performed in 2006 was $14 M.ConclusionFoot and ankle surgery accounts for a considerable degree of healthcare expenditure in Australia, and the number of procedures in those aged over 55 years is increasing. Given the ageing demographics of the Australian population, the future public health and economic impact of foot morbidity is likely to be substantial. Strategies need to be implemented to ensure that the surgical labour force is adequate to address this increasing demand.
Highlights
Foot and ankle problems are highly prevalent in the general community and a substantial proportion of people seek surgical treatment to alleviate foot pain and deformity
Data extraction from the Medicare Benefits Schedule database Data pertaining to foot and ankle surgical procedures for the calendar years 1997–2006 were extracted from the publicly accessible Medicare Benefits Schedule (MBS) database [9]
To simplify the interpretation of the results, item numbers relating to a similar region of the foot or a specific foot condition were combined into one of the following 12 categories: (i) toenail: wedge resection, partial resection and total removal of toenails; Surgical activity in Australia is continuously tracked by the Medicare Benefits Schedule (MBS) database [9], which records all services performed by registered providers that qualify for a Medicare benefit, with the exception of: (i) services provided by hospital doctors to public patients in public hospitals; (ii) services that qualify for a benefit under the Department of Veterans' Affairs, Work Cover or the Transport Accident Commission, and; (iii) services provided by podiatric surgeons
Summary
Foot and ankle problems are highly prevalent in the general community and a substantial proportion of people seek surgical treatment to alleviate foot pain and deformity. The epidemiology of foot and ankle surgery has not been examined in detail. The aim of this study was to examine patterns and costs of private sector foot surgery provision in Australia. Foot problems are reported by at least one in five people in the general population [1,2], and are associated with self-reported disability [3] and reduced health-related quality of life [2,4,5]. In Australia, provision of foot surgery is primarily the domain of specialist orthopaedic surgeons. General surgeons and general practitioners may perform foot and ankle surgical procedures, and a small number of surgically-trained podiatrists perform forefoot surgery in the private sector [6,7]
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