Health committee  First of all, I think one of the issues we haven't discussed is medically necessary services. For example, the Ontario government has looked at the schedule of benefits of what is insured and what is not insured, and they have determined certain procedures were publicly funded that are not medically necessary, if you will, for example, a lipoma benign cyst, a benign mole that has no threat on the patient's medical health.

Health committee  I want to start with some good news, and that is innovations in health care can save money. We often don't think about it that way, but when I was at the University of Ottawa, we were in transition from performing gallbladder surgery from an open procedure with a large incision and hospitalization for seven days and a six-week recovery from work to laparoscopic gallbladder surgery.

Health committee  It's all covered, yes.

Health committee  We absorb the cost.

Health committee  I'm not sure I understand the question.

Health committee  It's the procedure plus basically lifelong care. The fee is $18,000 for the program.

Health committee  Zero.

Health committee  In this particular case OHIP will cover other alternatives. It will cover the gastric bypass and another procedure called the sleeve, where you create a sleeve, but it currently doesn't fund the lap band.

Health committee  Yes. At the beginning we were doing more and more of them. We did hernia repairs, thyroid—

Health committee  No. That's the dilemma. When you look at the funding model, it's not sustainable to do it with the current structure of funding so that either then I choose to say, okay now, publicly funded procedures we'll still keep in the hospital for the time being, but in the future what we hope to see, and the provincial government has said this, is to do more and more procedures like cataracts and scopes, and I would add other procedures like hernia cases, properly and fully funded in and out of hospital facilities, much like they would fund them in a hospital, except we believe we can do it in a more cost-effective fashion.

Health committee  The provincial government is just starting the dialogue in Ontario on that with cataract surgery and endoscopy. But not only do we believe it's cost-effective, we believe we can deliver it more efficiently, that we can shorten the wait times substantially. As Dr. Sutherland mentioned, when you have specific funded procedures for wait times such as cancer operations, hip replacements, cataracts, what happens is there's a collateral effect on other procedures, such as hernias and gallbladder surgery.

Health committee  Yes. This is called the port, so this is a hollow—

Health committee  The port is attached to the muscle in the left mid quadrant, right here in the abdomen. You don't see it. It's actually underneath, attached to the muscle. We stitch it in the muscle.

Health committee  Our nurse, who also happens to have had a lap band by the way, does the adjustments. She has a patient lying down on their back with a slight arch on the back, with a pillow behind their back. Then she can palpate and feel the port. There's a special one-way needle she puts into the port and this is hollow and communicates with the circumferential balloon system, and you can fill the port with saline and, as a consequence, snug up the band, much like a belt.

Health committee  Currently in Ontario there are no specific arrangements with respect to out-of-hospital facilities and provincial government funding, except that we can perform publicly funded procedures and bill for the procedural fee alone. So that's currently the state of out-of-hospital facilities.