A need to cover overhead
Thal, presenting the veterinary point of view on these prices, counters with an explanation from Economics 101. "As for any
small business," he says, "the basic operating cost of doing business (overhead) is high for veterinary practice and continues
to increase. Equine veterinary practice has especially high overhead. A relatively large inventory, higher rates of liability
insurance, utility expenses for complex practices, fuel for mobile service, specialized staffing and all other costs are high
and continue to increase.
"Additionally," Thal says, "dedicated, highly trained equine professionals are hard to find, and they demand higher wages
for their higher level of training, commitment and professionalism."
These increasing costs are passed on to the consumer—in this case the horse owner—who passes them on to the insurance companies
who, in turn, increase their fees.
It is interesting to note that one particular area of equine healthcare is far and away more responsible for increasing insurance
costs than all others, and it is in this area that some changes may be made that might help halt the current cost increases.
The high cost of lameness
Even though colic may be the No. 1 cause of death in horses, according to the KBIS Guide to Riding and Sport Horse Insurance, most insurance claims are for lameness. In these lameness claims, 80 percent of the cost is for diagnosis, not treatment.
Some feel that equine veterinarians now spend a disproportionate amount of time, effort and their clients' money obtaining
a diagnosis. These individuals argue that many forms of lameness, regardless of diagnosis, will have no specific treatment
other than rest and reevaluation and that the overuse of high-tech, expensive diagnostic tests is driving up insurance costs.
Veterinary schools are also coming under fire because of the change in protocol for lameness diagnosis that has occurred over
the last 10 to 15 years. Students are so exposed to high-tech equipment, goes the argument, that the "art" of working up a
lameness is disappearing. Rather than an "old-school" stepwise series of nerve and joint blocks that accurately localize the
problem, many new graduates may do one or two blocks and then refer the horse for a more expensive diagnostic test. Critics
feel that incomplete field work-ups, reliance on high-tech tests and pursuit of a diagnosis that often does not change the
treatment or outcome is the source of current insurance issues.
Others, like Kent Allen, DVM, the chief veterinary services coordinator for the recent FEI World Cup Equestrian Games, disagree
on some points. While complete and accurate field work-ups are increasingly necessary and agreed to by all, pursuit of a diagnosis
still holds special purpose. "Absent a diagnosis, surgery is torture, medicine is poison and alternative therapy is witchcraft,"
is Allen's off-quoted mantra, meaning that a correct diagnosis is the first step in a scientific approach to any problem,
and any attempts at accurate treatment leading to a successful outcome begin there.
Clinicians in this camp argue that potentially more treatment money may be spent and more performance time lost by attempting
to manage a case without knowing what one is treating. These veterinarians also point out that while treatments and cures
have not kept pace with diagnostics, that gap is closing because researchers are continually evaluating how certain treatments,
medicines, procedures and techniques affect the outcome of cases.
These clinicians also argue that an accurate diagnosis must be made so that one can compare "apples to apples"—so that similar
forms of lameness can be evaluated with differing treatments, eventually leading to the best way to return that horse to athletic
function. Many equine veterinarians optimistically feel that the continued advance of good diagnostics leading to improved
treatments—many involving the rapidly developing field of regenerative medicine—will ultimately improve success rates. Additionally,
better, more accurate lameness diagnosis may lead to a better understanding of the causes of certain lameness. That information
is crucial to developing better methods of prevention, which has been shown in other areas such as colic and infectious diseases
to dramatically reduce cases and, ultimately, overall insurance costs.
An example of possible future cost savings
A case in point is the dramatic recent increase in the number and severity of cases of upper suspensory desmitis, especially
of the hind legs in sport horses. Goddard reports that "claims of upper suspensory desmitis, particularly of the hind legs
in dressage and show jumping horses, are becoming more common." It is not known why this particular condition has increased
in number and severity. "It might be the way these horses are trained," says Goddard, "or that there is an increasing demand
on these horses to perform."
Digital ultrasonography and MRI are high-tech, costly diagnostics being used to make this diagnosis. Tenotomy and fasciotomy
are somewhat expensive procedures, along with stem cell and platelet-rich plasma therapy that are being used for treatment.
Despite all of this, the prognosis for upper suspensory desmitis in the hind legs of sport horses remains guarded, depending
upon severity, and, according to Goddard, "in many cases the injury responds well to surgery, but again, the overall cost
of treatment will run into thousands of pounds."
Obtaining an accurate diagnosis in these cases may well shed light onto how these injuries occur—poor training, poor footing,
fatigue, shoeing concerns—which will be a first and major step toward prevention and a significant contributor to reducing
insurance claims and equine healthcare costs.
Dr. Marcella is an equine practitioner in Canton, Ga.