There are few things that undermine faith in Canada's health-care system more than the suggestion some citizens get better, quicker access to services than others.

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This article was published 19/4/2017 (1620 days ago), so information in it may no longer be current.

Opinion

There are few things that undermine faith in Canada's health-care system more than the suggestion some citizens get better, quicker access to services than others.

In a nation where the time you spend on a waiting list is the principal measurement for the quality of health care, the mere suggestion some people — perhaps famous, powerful or well-connected — are getting expedited access and preferential treatment is enough to cause the whole system to spasm with panic and anger.

That is certainly part of the reason Health Minister Kelvin Goertzen has reacted with such alarm to a Free Press story that suggested some residents of our province may have got preferential access to MRI scans. The story was based on a confidential list compiled by Manitoba Auditor General Norm Ricard, and acquired by the newspaper, of famous, powerful and influential Manitobans who appeared to have jumped the queue.

The confidential list contained the names of politicians, philanthropists, senior bureaucrats in the Winnipeg Regional Health Authority, physicians and professional athletes. The WRHA followed up with a more detailed audit of cases involving senior WHRA officials and found no evidence they knowingly received preferential treatment.

Still, the WRHA has pledged to make improvements to the system, to close loopholes and plug blindspots that seemingly allow some people to jump the wait lists. In some instances, however, the quirks of the system that give automatic priority to certain patients will remain.

One of those areas is the Workers Compensation Board. Thanks to an amendment to the Canada Health Act more than 30 years ago, provinces are allowed to sell medical services to anyone covered under a WCB claim. That means everything from a MRI, to physiotherapy and surgery deemed necessary by the WCB is actually purchased separately by the WCB.

The WCB made a $1.5-million contribution to the cost of acquiring and installing the scanner at the Pan Am Clinic. In exchange,the WCB gets preferential access to a certain number of scans and pays more than $800 per scan for that privilege, considerably more than it costs to provide this service.

It is a loophole, but one that comes with a medical argument that anyone injured on the job deserves to be treated on an expedited basis to get them back to work. It's debatable, of course, about whether those patients should be moved to the front of the line, but that is the way the system is structured.

Less clear is the practice of providing professional and elite athletes with MRIs on demand.

Injured members of the Winnipeg Jets, the hockey club's farm team and the Blue Bombers regularly receive very quick access to MRIs. Like the WCB, the teams pay a price for each scan. This appears to include MRIs for initial diagnosis of an injury and followup scans as they attempt to heal and get back in the game.

This is not legal, per se, but it does reflect a couple of inescapable realities about professional athletes. First, many are not residents of Manitoba and thus are not covered by the public health-care system. Second, physicians will make a medical argument an injured athlete deserves expedited service because he or she cannot function until they are healed. Certainly, they would argue athletes deserve to be treated well ahead of those who are injured but still able to do most of what they were able to do before they were hurt.

However, while it may be fun to debate the morality of giving professional hockey and football players preferential access to health services, that is not the real issue here. More important is the concern that across the entire health-care system, who you know can often determine what kind of treatment you get, and when you get it.

In some jurisdictions, the practice is called "professional courtesy" and refers to the decisions some physicians make to give colleagues, family, friends and family of friends expedited access to services most people must wait to access. It is a little-studied phenomenon and thus hard to quantify. However, we do know it exists.

Physicians are the gatekeepers of almost all medical services. A physician determines whether someone needs a scan or a procedure, and other physicians often determine how soon someone should be treated. The power physicians wield over who gets treated and when is not a concern when the principles of universal access are applied.

However, that's not always the case. A 2013 public inquiry in Alberta established while preferential access was a "minor problem" within the broader challenges facing the health-care system, many opportunities existed to end the practice. The inquiry produced 12 recommendations, many of which were addressed by the province.

The College of Physicians and Surgeons of Alberta ultimately issued a directive to its members to guard against making room for unscheduled visits from colleagues, friends and family. Although the directive was generally considered to be less than what was necessary to curb the practice of professional courtesy, it was a warning shot nonetheless.

The Manitoba College of Physicians and Surgeons has not, to date, issued a similar directive. The WRHA is, however, working on a series of measures that could help ensure more equitable access to services. These include central waiting lists for high-demand elective procedures, more consistent application of priority ratings when a physician orders a procedure or test, and even preliminary examinations of patients referred to see a surgical specialist to ensure they actually need surgery.

Ricard's original list may not have been entirely fair to the people that were included. However, his work has shone a light on an issue that has been deliberately overlooked for a very long time. And that, it appears, was worth the wait.

dan.lett@freepress.mb.ca

Dan Lett

Dan Lett
Columnist

Born and raised in and around Toronto, Dan Lett came to Winnipeg in 1986, less than a year out of journalism school with a lifelong dream to be a newspaper reporter.

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