December 7, 2013 Sections
Winnipeg Free Press - PRINT EDITION
Canada's premiers, facing a future of curbed federal transfers, are turning their minds to stemming the rising cost of health care. Negotiating better prices on generic drugs remains high on the list of their priorities, but the premiers looked a little deeper at where all the money in health budgets is going. At their recent premiers conference, they landed on the escalating expense of diagnostic imaging.
Improving access to diagnostic tests -- MRI, CT, ultrasound -- was targeted a decade ago in a national accord with the former Liberal government in Ottawa. Diagnostic imaging is a factor in cutting wait times generally because a delay in refining diagnosis can delay referral to a specialist or the start of a treatment regimen.
Successive federal governments transferred billions of additional dollars to the provinces for the purchase of new machines, driving up the cost of health care -- diagnostic imaging now costs more than $22 billion annually -- as provinces hired staff to keep the machines working longer hours. Doctors responded by sending many more patients into the queues for tests.
A number of small studies in provinces have found some overuse and inappropriate ordering of diagnostic testing, but there have been no large-scale national studies, making broad estimations difficult. Inappropriate testing unnecessarily subjects patients to the risks inherent in radiation exposure. The Canadian Association of Radiologists, meanwhile, points out incidental findings can trigger further diagnostic testing, which often end in a benign diagnosis. The association publishes guidelines for when to order diagnostic imaging, but experience shows not all physicians adopt the rules.
The premiers agreed to set common rules for ordering diagnostic tests, starting with lower back, minor head injuries and headaches.
The radiologists association notes the factors behind inappropriate testing are complex: family docs are challenged to keep up with the speed of developing best practices and the way hospital resources are organized can make ordering a diagnostic image the easier triage option when ER beds are scarce.
This is a case of a problem everyone suspects exists yet has been poorly documented. Physicians, CAR notes, must be free to exercise their best judgment as good medicine is science and art. The Selinger government should press doctors to respect best practice and setting national guidelines encourages that. The best check on overuse may be regular audits of physicians' ordering of tests, to ensure they can account for the routine, but costly decisions they make.
Republished from the Winnipeg Free Press print edition August 6, 2013 A10