OHIP and the Duodenal Switch

There has been much talk lately in the world of weight loss surgery support boards that OHIP, the Ontario Health Insurance Provider, is tightening up on the approval for the DS. There is rumour that the DS will be reserved for people with higher BMI's... whatever that means. Although I clearly do not KNOW what is going on, I have some thoughts that I need to share.

1. Part of the discussion has been questioning the cost of duodenal switch surgery. The DS can, and I say can because I have heard of gastric by pass surgeries that have been comparable in cost, cost more. Not significantly more but in the 10 - 20% range more. As a public entity OHIP does have the right and obligation to show all due financial concern when considering funding for any type of surgery or medical care. I don't have an issue with this.

What I do have an issue with is if upfront cost is the only consideration. I would hope that the increased chance of regaining weight and therefore a return of obesity related diseases associated with other surgeries are factored into the equation. For that matter if you simply took a $ per EWL% the cost of the DS actually comes out lower. On average you lose a greater percentage of your excess weight with the Duodenal Switch. By extrapolation this means that you should see a corresponding decrease in weight related health issues.

2. Denying the DS based on lower BMI's is misinformed at best. The DS is tailored to each individual. The surgeon will decide how long your common channel needs to be based on your current weight and the goal weight. This part of the surgery can be revised. The DS works for people like me who had a starting BMI of 50+ but it can also work well for people who have BMI's in the 35 - 50 BMI range.

3. Complications. Complications occur with all surgeries. The DS is no different. I have a sense that some of the current thinking may be as a result of some of these complicated cases. I would hope that someone with a bent for statistics is looking at the complication rate vs one or two cases that are currently on their radar screen,

4. The lapband will now be funded. Does this means that one WLS has to drop off the books? Lets think about the overal success rate with the lapband? It nowhere compares to either the DS or Gastric By Pass.

Lastly and most importantly I hope that OHIP is considering all the research that clearly indicates that the Duodenal Switch is the superior weight loss surgery. It is a riskier surgery. It is less readily available because of the complexity but if people make the choice to go with the surgery that, today, is considered superior then it should be something that OHIP supports as a long terms solution to decreasing weight related illnesses, not something that is measured merely on the opening line of a balance sheet.

I sincerely hope that the rumours are just that. Talk without basis. Not having the DS funded would be a huge disservice to Ontarians who are seeking to surgerically manage their weight.