Evidence shows private MRI tests won’t cut the wait

Hey there, time traveller!
This article was published 05/12/2016 (3613 days ago), so information in it may no longer be current.

It was one of the better days for the ragged NDP opposition.

Last week, Health Minister Kelvin Goertzen suggested he was “willing to look” at copying a Saskatchewan initiative that allows people to pay for MRI tests at private clinics to relieve pressure on the public system. In exchange for being able to charge directly for a scan, private MRI clinics have to provide one free scan to someone on the public waiting list.

The mere suggestion was enough to send the NDP into an apoplectic fit.

In question period Friday, the NDP lashed out at Goertzen for his interest in a program the federal government has deemed illegal under the Canada Health Act. Two-tier health care remains a flashpoint between the right and left wings of the Canadian political spectrum, as was witnessed in the Manitoba legislature last week.

NDP critic Matt Wiebe put it bluntly. “This is the first step in (the Tory government’s) plan to create a two-tier health system, where the size of your wallet determines your care.” Goertzen brushed aside the attack, but he stuck to his assertion he would adopt any idea that helps improve service and control costs.

Goertzen is not wrong to look for any and all ways of making the health care system more efficient and effective, including possible public-private hybrids. However, he surely knows there are no quick fixes or magic bullets.

Provinces, with the support and urging of the federal government, have been working steadily in the past 20 years to improve outcomes and lower wait times, spending billions of dollars in the process to improve technology, processes and overall management.

While the health care system is undoubtedly providing more services to more people than ever, no one has been able to find a definitive way of slowing the upward pressure on health spending.

Many within the system believe allowing private, for-profit options is a potential solution. Government has always relied on private facilities such as walk-in clinics, X-ray clinics and laboratories to provide insured services within the public system. Perhaps it’s time to allow Canadians to purchase medical services on the open market.

You will hear this argument often from surgeons, many of whom claim they do not get enough work in the public system. However, surgeons are not the only professionals necessary to perform a surgical procedure.

Depending on the type of surgery, you need radiologists to assess X-rays or scans, surgical nurses and anesthesiologists to help with the procedure, and more nurses to oversee post-operative care.

Although a province may have an oversupply of surgeons, it has a shortage of the other disciplines. The hours nurses and anesthesiologists work in the private system would come at the expense of the hours they can devote to the public system.

This is a key caveat on the argument in favour of allowing more private, for-profit health care options: it is difficult to create a private tier that does not ultimately weaken the public tier. In fact, it is tough to find examples where increased private options relieve pressure on the public system and reduce wait times.

There is some evidence of this in Saskatchewan, where the government has been allowing private, for-profit MRIs for about 10 months. To date, Saskatchewan claims it has taken 2,200 patients off public wait lists for MRIs. And yet, its wait times in the public system have not gone down.

In fact, during the first six months Saskatchewan allowed residents to purchase their own MRI tests, the government’s own website shows wait times went up.

It is too early to tell if this is a longer-term trend or if it is why wait times have gone up. But it’s fair to say this private option hasn’t increased Saskatchewan’s overall capacity to perform MRIs. It has, however, allowed a few citizens to purchase better service.

Therein lies the problem for all governments of all political stripes. There are no easy solutions, and simply opening private MRI clinics is not going to improve the overall performance of the system.

If opening a few new MRI scanners improved access to the service, then Manitoba would have beaten this problem a long time ago.

In 1999, the NDP made a big push to provide more resources for diagnostic testing. During the next 17 years, hundreds of millions of dollars were spent adding MRIs and CTs and extending the hours of operation. The sheer number of scans performed in Manitoba went up exponentially. Ironically, so did wait times.

During the past 20 years, the province has gone from three to eight MRIs, and doubled its inventory of CTs to 16, allowing for a huge increase in the number of scans.

According to statistics provided by the province, in 1999, Manitoba performed about 6,000 MRI tests and 50,000 CT scans. By 2015, the province had increased total scans to 50,000 MRI tests and 180,000 CT scans. And yet, wait times have gone up.

In 2001, the province reported a nine-week average wait for an MRI test; by 2004, after bringing an additional MRI online in Brandon, the wait went up to 15 weeks. Two years later, after bringing yet another MRI online at the Pan Am Clinic, the average wait went up again to 18 weeks. Today, with eight MRIs operating, non-urgent patients generally have to wait more than 20 weeks to get a scan.

The factors behind this equation are hotly debated. Many health care economists believe the driving force is a rash of unnecessary tests.

Some physicians dispute this assertion, but there is evidence suggesting that every time the province opens a new MRI or CT, doctors simply order more tests. Nobody ever gets any further ahead.

There is nothing wrong with Goertzen studying the Saskatchewan MRI program — as long as he understands this is not the magic bullet to reduce MRI wait lists. And further, that there really isn’t a magic bullet to be had.

dan.lett@freepress.mb.ca