Quality Versus Access Dilemma

A. Pieter Kappetein, MD, PhD discusses challenges in delivering quality care to remote regions.

A. Pieter Kappetein, MD, PhD discusses challenges in delivering quality care to remote regions.

Bringing quality cardiothoracic surgical care to underserved regions is rife with challenges. Managing costs, staffing, training, equipment needs, and follow-up care are overwhelming concerns. These are compounded when a lack of access hinders patients from getting treatment. Quality, access, financial, and ethical considerations also are paramount issues when providing cardiothoracic surgical care in the midst of a humanitarian crisis.

Monday’s International Symposium examined the quality versus access debate for underserved regions and for countries responding to refugees who have fled en masse.

The Symposium kicked off with presentations comparing the costs and benefits of regionalized cardiothoracic surgical care and localized care in lower-volume centers.

“People in some areas of the world have a great distance between where they live and where they can access care,” moderator A. Pieter Kappetein, MD, PhD, of Erasmus Medical Center in Rotterdam, the Netherlands, said in an interview prior to the Symposium. “This is not limited to developing countries. It is also true for the Western world. You can strive for the best and the most excellent center of excellence, but that’s not always possible.”

Although some argue that low-volume centers have good outcomes, others say highly specialized centers are needed because cardiac surgery patients are complex, Dr. Kappetein said. The speakers shared their experiences setting up sustainable specialized centers in Nepal and South Africa.

Another speaker gave his take on the quality, access, financial, and ethical challenges involved in the Syrian refugee crisis.

“About 65 million people have been displaced from their homes; 21.3 million of them are refugees for whom flight is virtually necessary—involuntary victims of politics, war, or natural catastrophe. Surgeons face challenges in determining how we can help,” Dr. Kappetein said.

The session concluded with a presentation on the global challenge of treating noncommunicable diseases, including cardiothoracic diseases.

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