Abstract
The majority of patients with spinal deformities need some type of treatment. Typically, physiotherapy and bracing are sufficient and a minority of cases require surgical treatment. However, in many international papers on spinal deformities surgical issues are investigated while conservative management of spinal deformities is definitively underrepresented. The purpose of this survey is to look more deeply into the implications of the surgical societies and spine surgeons lobbyism on the payroll of industry and how these groups influence payments (reimbursement) made by national health services or health insurance systems worldwide for the treatments of patients with spinal deformities. Materials and methods: An international network of specialists for the conservative treatment of spinal deformities have performed a survey analyzing the cost of spinal surgery for spinal deformities (scoliosis), the cost of a brace and whether insurance/the NHS reimbursement applies with surgery or bracing. Results: In most countries surgery is paid without co-payments by the patient. In Japan, China and Ukraine co-payments are necessary for surgery. There are more restrictions when looking at payments for braces. In some countries, braces are not covered by the health care systems or insurance companies at all (China, Indonesia) in others the amount covered is only minimal (Turkey, Ukraine). Conclusions: Evidence in scientific literature is not reflected in the political decision making in parliaments. Evidence based treatment approaches for patients with spinal deformities are not necessarily reimbursed by local health care systems while surgery without scientific evidence is reimbursed more easily although it is more expensive. The most economic approach would be to pay for high quality conservative treatment in order to largely prevent the need for surgery. Surgical indications should be approved by an independent non-surgical specialist for spinal deformites.
Highlights
The majority of patients with spinal deformities will not need spinal surgery [1,2,3,4]
Within our international network of specialists for the conservative treatment of spinal deformities we have performed a survey containing the following queries: 1. Country: 2. Cost of spinal surgery for spinal deformities: 3. Cost of a brace: 4. Is surgery reimbursed by the insurance / NHS: 5. Is a brace reimbursed by the insurance / NHS: 6. In case 4=yes; are all kinds of surgery reimbursed
Even if one assumes the previously used threshold for the surgical treatment of an idiopathic scoliosis with a curvature of 40-50°, only a minority of those affected would need an operation. This means that the majority of cases with scoliosis and kyphosis would warrant conservative management with physical rehabilitation and brace treatment [5, 6, 22,23,24,25,26]. When it comes to monetary reimbursement of treatment, even in emerging countries like China and Indonesia it is easier to receive payment for surgery than for International Journal of Health Economics and Policy 2020; 5(1): 9-14 conservative treatment including brace treatment, which is regarded as being evidence based
Summary
The majority of patients with spinal deformities will not need spinal surgery [1,2,3,4]. When compared to patients with scoliosis, patients with kyphosis have a better prognosis [5, 6]. The majority of all scoliosis cases are patients with adolescent idiopathic scoliosis (AIS) comprising 80 – 90% of all scoliosis cases. These patients with AIS are otherwise healthy and even when staying untreated they will not suffer from severe health problems [1,2,3,4]. The majority of patients with a kyphosis have Scheuermann’s kyphosis, a deformity not leading to severe health issues. For most of the patients requiring treatment, physiotherapy and bracing will be sufficient and only the minority of the cases would need surgical treatment [5, 6]
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