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Improving access to surgical care for Inuit communities in Nunavik: a cost-savings analysis of a surgeon outreach program.

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Title: Improving access to surgical care for Inuit communities in Nunavik: a cost-savings analysis of a surgeon outreach program.
Authors: Mashal S; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt)., Caminsky NG; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt)., Campbell JR; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt)., Boulanger N; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt)., Watt L; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt)., Grushka JR; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt)., Fata P; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt)., Deckelbaum DL; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt)., Khwaja K; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt)., McKendy K; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt)., Jastaniah A; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt)., Wong E; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt). evan.wong@mcgill.ca.
Source: Canadian journal of surgery. Journal canadien de chirurgie [Can J Surg] 2026 May 01; Vol. 69 (3), pp. E221-E229. Date of Electronic Publication: 2026 May 01 (Print Publication: 2026).
Publication Type: Journal Article; Research Support, Non-U.S. Gov't
Language: English
Journal Info: Publisher: Canadian Medical Association Country of Publication: Canada NLM ID: 0372715 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1488-2310 (Electronic) Linking ISSN: 0008428X NLM ISO Abbreviation: Can J Surg Subsets: MEDLINE
Imprint Name(s): Publication: Ottawa : Canadian Medical Association
Original Publication: Toronto, Canadian Medical Assn.
MeSH Terms: Health Services Accessibility*/economics , Cost Savings*/statistics & numerical data , Inuit*/statistics & numerical data, Travel/economics ; Humans ; Quebec
Abstract: Background: Access to timely surgical care in remote regions remains a substantial challenge. We sought to evaluate the societal costs of 2 models for delivering general surgery consultations to Nunavimmiut patients, namely an outreach model involving specialist travel to the Inuulitsivik Health Centre in Puvirnituq, and the traditional model requiring patient transfer to urban tertiary care in Montréal.
Methods: We conducted a cost analysis for all general surgery consultations from May 30, 2022, to May 24, 2024, corresponding to the first 2 years of the specialist travel program. We estimated costs across 4 representative 1-week travel periods. Direct costs included surgeon remuneration, travel, and local service expenses. Indirect costs accounted for lost wages based on the median Nunavik income. Assumptions on travel duration, accommodations, and interpreter services were based on provincial data and Ullivik historical records.
Results: The specialist travel model was consistently less costly across all periods analyzed. Patients seen in Puvirnituq incurred lower direct and indirect costs than those transferred to Montréal. The annual cost for urban-based care was $1.86 million compared with $163 000, leading to potential cost savings of $1.7 million annually or $12 000 per consultation. Sensitivity analyses confirmed cost advantages under a broad range of assumptions.
Conclusion: Deploying specialists to Puvirnituq for surgical consultations is a cost-effective alternative to patient displacement. This model holds promise for improving equitable access to care in remote communities while reducing the financial burden on health care systems.
(© 2026 CMA Impact Inc. or its licensors.)
Competing Interests: Competing interests:: Dan Deckelbaum is board chair with Deck Therapeutics. Evan Wong reports grant support from the Canadian Association of General Surgeons and the Montreal General Hospital Foundation. No other competing interests were declared.
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Int J Circumpolar Health. 2015 Oct 26;74:29576. (PMID: 26507717)
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Int J Circumpolar Health. 2004 Dec;63(4):415-21. (PMID: 15709316)
J Trauma. 2009 Aug;67(2):358-65. (PMID: 19667890)
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Entry Date(s): Date Created: 20260501 Date Completed: 20260716 Latest Revision: 20260813
Update Code: 20260813
PubMed Central ID: PMC13155878
DOI: 10.1503/cjs.013525
PMID: 42067206
Database: MEDLINE
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  Data: Improving access to surgical care for Inuit communities in Nunavik: a cost-savings analysis of a surgeon outreach program.
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  Data: <searchLink fieldCode="AU" term="%22Mashal+S%22">Mashal S</searchLink>; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt).<br /><searchLink fieldCode="AU" term="%22Caminsky+NG%22">Caminsky NG</searchLink>; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt).<br /><searchLink fieldCode="AU" term="%22Campbell+JR%22">Campbell JR</searchLink>; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt).<br /><searchLink fieldCode="AU" term="%22Boulanger+N%22">Boulanger N</searchLink>; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt).<br /><searchLink fieldCode="AU" term="%22Watt+L%22">Watt L</searchLink>; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt).<br /><searchLink fieldCode="AU" term="%22Grushka+JR%22">Grushka JR</searchLink>; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt).<br /><searchLink fieldCode="AU" term="%22Fata+P%22">Fata P</searchLink>; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt).<br /><searchLink fieldCode="AU" term="%22Deckelbaum+DL%22">Deckelbaum DL</searchLink>; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt).<br /><searchLink fieldCode="AU" term="%22Khwaja+K%22">Khwaja K</searchLink>; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt).<br /><searchLink fieldCode="AU" term="%22McKendy+K%22">McKendy K</searchLink>; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt).<br /><searchLink fieldCode="AU" term="%22Jastaniah+A%22">Jastaniah A</searchLink>; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt).<br /><searchLink fieldCode="AU" term="%22Wong+E%22">Wong E</searchLink>; From the McGill Faculty of Medicine, Montréal, Que. (Mashal); the Division of Trauma and General Surgery, McGill University Health Centre, Montréal General Hospital Site, Montréal, Que. (Caminsky, Grushka, Fata, Deckelbaum, Khwaja, McKendy, Jastaniah, Wong); the Department of Global and Public Health, McGill University Health Centre, Montréal, Que. (Campbell); the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Boulanger, Watt). evan.wong@mcgill.ca.
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  Data: <searchLink fieldCode="JN" term="%220372715%22">Canadian journal of surgery. Journal canadien de chirurgie</searchLink> [Can J Surg] 2026 May 01; Vol. 69 (3), pp. E221-E229. <i>Date of Electronic Publication: </i>2026 May 01 (<i>Print Publication: </i>2026).
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Canadian+Medical+Association%22">Canadian Medical Association </searchLink><i>Country of Publication: </i>Canada <i>NLM ID: </i>0372715 <i>Publication Model: </i>Electronic-Print <i>Cited Medium: </i>Internet <i>ISSN: </i>1488-2310 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%220008428X%22">0008428X </searchLink><i>NLM ISO Abbreviation: </i>Can J Surg <i>Subsets: </i>MEDLINE
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  Data: <i>Publication</i>: Ottawa : Canadian Medical Association<br /><i>Original Publication</i>: Toronto, Canadian Medical Assn.
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  Data: <searchLink fieldCode="MM" term="%22Health+Services+Accessibility%22">Health Services Accessibility*</searchLink>/<searchLink fieldCode="MM" term="%22Health+Services+Accessibility+economics%22">economics</searchLink> <br /><searchLink fieldCode="MM" term="%22Cost+Savings%22">Cost Savings*</searchLink>/<searchLink fieldCode="MM" term="%22Cost+Savings+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> <br /><searchLink fieldCode="MM" term="%22Inuit%22">Inuit*</searchLink>/<searchLink fieldCode="MM" term="%22Inuit+statistics+%26+numerical+data%22">statistics & numerical data</searchLink><br /><searchLink fieldCode="MH" term="%22Travel%22">Travel</searchLink>/<searchLink fieldCode="MH" term="%22Travel+economics%22">economics</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Quebec%22">Quebec</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Access to timely surgical care in remote regions remains a substantial challenge. We sought to evaluate the societal costs of 2 models for delivering general surgery consultations to Nunavimmiut patients, namely an outreach model involving specialist travel to the Inuulitsivik Health Centre in Puvirnituq, and the traditional model requiring patient transfer to urban tertiary care in Montréal.<br />Methods: We conducted a cost analysis for all general surgery consultations from May 30, 2022, to May 24, 2024, corresponding to the first 2 years of the specialist travel program. We estimated costs across 4 representative 1-week travel periods. Direct costs included surgeon remuneration, travel, and local service expenses. Indirect costs accounted for lost wages based on the median Nunavik income. Assumptions on travel duration, accommodations, and interpreter services were based on provincial data and Ullivik historical records.<br />Results: The specialist travel model was consistently less costly across all periods analyzed. Patients seen in Puvirnituq incurred lower direct and indirect costs than those transferred to Montréal. The annual cost for urban-based care was $1.86 million compared with $163 000, leading to potential cost savings of $1.7 million annually or $12 000 per consultation. Sensitivity analyses confirmed cost advantages under a broad range of assumptions.<br />Conclusion: Deploying specialists to Puvirnituq for surgical consultations is a cost-effective alternative to patient displacement. This model holds promise for improving equitable access to care in remote communities while reducing the financial burden on health care systems.<br /> (© 2026 CMA Impact Inc. or its licensors.)
– Name: Abstract
  Label: Competing Interests
  Group: Ab
  Data: Competing interests:: Dan Deckelbaum is board chair with Deck Therapeutics. Evan Wong reports grant support from the Canadian Association of General Surgeons and the Montreal General Hospital Foundation. No other competing interests were declared.
– Name: Ref
  Label: References
  Group: RefInfo
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              Text: 2026 May 01
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