Varicose Veins Treatment
Understanding the nuances in practice across Melbourne and Australia for the treatment of varicose veins.
The costs of treatment vary quite considerably based on the severity of your venous disease, as well as whether or not you have private health insurance, level of coverage and whether or not you are patient enough to wait to be seen in the public health sector.
Public funding for treatment of varicose veins.
Any patient with a medicare card can be referred to the public health care system to be seen for consideration of treatment of their varicose veins. Unfortunately, the public sector cannot sustain treatment of every single patient with varicose veins- otherwise it would be overwhelmed. Consequently, the public health sector is designed to primarily treat people with complications from their varicose veins. This means patients with visible leg swelling or worse (venous ulcers). The Victorian governments stance on the public treatment of varicose veins can be found on the Department of Health Website (https://src.health.vic.gov.au/varicose-veins). Generally, the Victorian Government is happy to fund in hospital treatment for patients who have C3 disease or greater.
Importantly, pain is not listed as one of these indications. As such patients with painful veins who cannot access the public sector should consider compression garments while awaiting assessment. As this is not strictly an indication funded for in the public sector, being offered surgery varies quite significantly according to the hospital in which you are being seen.
The wait times vary quite significantly again. Some hospitals which have embraced minimally invasive treatment and as such have significantly reduced their wait times for assessment and surgery. Another factor to consider is that some hospitals, particularly those that have been designated as COVID streaming hospitals in Melbourne have put their venous treatments on hold.
Some hospitals now offer minimally invasive treatment options such as radiofrequency ablation (RFA). However, it is important to note that the public sector is designed to treat and heal venous ulcers. As such, those with primarily cosmetic concerns will most likely not get the result they desire.
Treatment in the private sector comes in many shapes and sizes. Generally this involves treatment in a practitioners rooms or in a private hospital. Patients with top level private cover are generally covered for treatment in hospital. However, this treatment can only be carried out by a vascular surgeon (denoted by the qualifications FRACS – Fellow of the Royal Australian College of Surgeons). Although many non vascular surgeons still provide good treatment for varicose veins, they generally will not have operating rights within a private or public hospital – and thus the patient will need to pay to have the procedure performed in rooms. Some surgeons will still charge a “Gap” payment. This is an additional amount on top of your hospital excess.
Therefore for patients with top level cover, cost = hospital excess as per insurance policy + surgeons gap + anaesthetist cost. The gap for a surgeon can ranges generally from $500 to a few thousand dollars. The anaesthetist cost is usually around $500. Note however, this is an estimate only and a quote is required prior to proceeding with surgery. For insured patients, Mr Farah charges a gap of $500.
In room treatment is becoming a more common option with modern minimally invasive techniques. These allow patients to have “walk in/walk out” same day treatment without the need for general anaesthesia or sedation. This allows patients without private health insurance, or venous disease not severe enough to require public hospital treatment to have their veins treated. However, the costs of consumables, staffing, rent, dressings and stockings need to be covered by the patient. Medicare does provide a rebate of around $500. The costs for this vary greatly according to who is doing the procedure and where they work, but range from $2000-$4000 per leg treated. In some very rare instances minimally invasive treatment may fail for a number of factors. In this situation, it can be difficult to manage patients who are not insured as the next step may involve general anaesthesia and traditional open surgery.
Sclerotherapy is a non surgical treatment for varicose veins. Sclerotherapy is used to injury the veins and cause them to become irritated and stick together. This leads to damage of the veins, but in doing so causes them to scar and shrink. The veins eventually disappear altogether.
Is the cost of sclerotherapy the same?
Generally no, sclerotherapy is cheaper. It is used to treat surface and spider veins, but it is not as good as treating patients with larger veins with more significant reflux. Again, costs vary from practitioner to practitioner but can range anywhere from $400- $2000 per leg.
What is a vascular surgeon?
A vascular surgeon is a medical specialist that has obtained recognition from the Royal Australasian College of Surgeons in the speciality of vascular surgery. The vascular surgery training program is a highly competitive training program that doctors enter after completing medical school, internship, residency and research. There are generally 8 to 10 individuals selected into this training program across Australia and New Zealand per year. Vascular surgeons then embark on a 5 to 6 year training program where they spend each individual year in a different tertiary public teaching hospital. There are several examinations throughout this time. Many of these surgeons adopt the title of “Mister” or “Miss”, denoting their specialist training in the art of surgery after successful completion of their training.
What are the advantages to seeing a vascular surgeon?
There are many doctors who offer treatment for varicose veins – many of them are not vascular surgeons. Although many of these doctors have completed medical school and internship and residency, they have not been formally trained in surgery. Although we recognise that many of these doctors have become experts in their own right and do provide excellent treatment for varicose veins, seeing a vascular surgeon has certain advantages. A vascular surgeon can offer both treatment in hospital (public and private) as well as the full complement of both minimally invasive and open surgical options. Furthermore, some treatment for varicose veins can be provided for free in the public sector and paid for via medicare. If you are entitled to free, publicly funded treatment you should have the opportunity to do so.
Patients can only access publicly subsided treatment by seeing a surgeon who is a Fellow of the Royal Australasian College of Surgeons, and thus holds the title F.R.A.C.S.
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© Sam Farah 2021