The non-medical surgical assistant and inequity in the Australian healthcare system

Toni Hains, David Rowell, Haakan Strand

    Research output: Contribution to journalReview articlepeer-review


    Objectives: The objective of this discussion paper is two-fold. The first is to quantify if the non-medical surgical assistant increases access to surgery by investigating what percentages of cases these clinicians undertake in the private sector surgical units where they work. The second is to examine procedural and distributive justice and how they impact on private sector surgical care. 

    Aim: The aim of this paper is to investigate if the non-medical surgical assistant increases equity via access, for the patient, to private sector surgical care; and if government policy has an impact on equity in the form of access. 

    Background: The private healthcare sector completes approximately two-thirds of all elective surgery in Australia; without this contribution, there would be more pressure on the public healthcare sector. In the private sector, recognition and federal funding of the surgical assistant differs depending on whether this clinician has a medical or non-medical, eg. nursing, qualification. The role of the non-medical surgical assistant is well established internationally and this role has been practiced in Australia for more than 20 years. 

    Discussion: Inequity; as a result of the procedural injustice of government funding policy, impacts the private sector surgical patient causing distributive injustice. This distributive injustice results in an out-of-pocket expense to the patient. Rising outof-pocket expenses has started a trend of patients moving away from private health insurance and into the public sector. The registered nurse and nurse practitioner are qualified to practise as a non-medical surgical assistant and provide increased access to care, and effective care compared to the medical surgical assistant. The nurse practitioner is an eligible provider of Medical Benefits Schedule services but restricted from accessing the intraoperative assisting item numbers. 

    Conclusion: The non-medical surgical assistant; or at least the nurse practitioner as non-medical surgical assistant; require access to the Medical Benefits Schedule intraoperative item numbers. Access would alleviate the out-of-pocket expense incurred by Australian patients when a non-medical surgical assistant assists with their surgery. Lack of access to these item numbers means patients may have their surgery delayed until an appropriately skilled medical surgical assistant is available, or the public healthcare sector can accommodate them. 

    Implications for research, policy and practice: This paper illustrates a need for change in Australian government policy to reflect contemporary, evidencebased practice. 

    What is already known about the topic?: • The international literature reports that advanced practice nursing roles increase access to healthcare. • The nurse practitioner role in Australia is now well established, and the Australian literature illustrates increased access to care. • The Medical Benefits Schedule Review Taskforce was formed to investigate a system that is not consistent with contemporary, evidence-based healthcare. 

    What this paper adds: • The nurse practitioner and registered nurse, in the role of non-medical surgical assistant, increase access to private sector surgical care. • Australian government policy limits access to private sector surgical care through its inequitable policies that contravene the spirit of fair trade. • According to peak professional bodies’ policy and position statements, the nurse practitioner and registered nurse are legitimate providers of surgical assisting services.

    Original languageEnglish
    Article number2020.374.278
    Pages (from-to)59-67
    Number of pages9
    JournalAustralian Journal of Advanced Nursing
    Issue number4
    Publication statusPublished - 1 Sept 2020


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