Free access thesis.
I said in the introduction: "The concept of day surgery is new in the Spanish health care system, but this innovatory practice has incentives to be further developed in the context of the reform of the NHS. It is often said that it reduces expenditure on health care or increases surgical activity within a given budget, whilst at the same time maintains or improves the quality of care offered to patients (The Royal College of Surgeons, 1992; The Audit Commission, 1992; Beech and Morgan, 1992). Day case surgery appears to be an ideal altemative to inpatient care, from the point of view of the purchasers (those who pay for medical care, the NHS) as well as for those who provide it (hospitals and health professionals), and fínally the patients."
15 years later data in Catalonia (2013) shows that the number of surgical procedures being performed as day surgery is 47,8% (substitution index) 2013 Results Centre Reports*. In Denmark 70-75%.
An European Report (2013) Day Surgery policy brief (2013) says:
" Day Surgery constitutes a missed opportunity for the improvement of surgical services, especially within the public sector component of many health systems, typifying the huge know-do gap between clinical and organizational evidence and service provision. In the future, European health systems will increasingly face an ethical and political dilemma regarding approaches that assure sustainable and equitable access to effective and safe procedures. Day Surgery adoption is part of the answer to such complexity.
The question "Is this patient suitable for day surgery’ should be replaced by ‘Is there any justification for admitting this case as an inpatient?"
* Next month the 2014 data will be available
2014 Results Centre Reporta:
Substitution index 2013: 57,5% Why this difference? (47,8% published in 2013)
Substitution index 2014: 58,4%