October 27, 2014
Premier Brad Wall
Dear Mr. Premier,
You have opened the discussion about introducing private pay-as-you-go MRI scans in Saskatchewan and asked for comments on this proposal.
The opening of this discussion seems to come not from a policy point of view, but rather from the fact that a private company has applied for a licence to establish private MRI. Up front this does not seem to be a good way to implement such a major change to our much valued health care system.
The introduction of private MRI`s in Saskatchewan flies in the face of the principles of our Medicare system. Not only is it not a principled position it is in defiance of the Canada Health Act. As you are quoted as saying in a Saskatoon Star Phoenix article in 2008 “offering medical services such as an MRI for a fee seems to be outside the Canada Health Act and is an area where the government doesn’t want to tread.” What changes have occurred that you no longer question that?
We do not need a two-tiered health care system. Quite simply, it is in-equitable. People who can afford the cost will be fast-tracked through the system. Once the MRI is complete and a diagnosis made which requires further treatment such as surgery, is the patient then placed ahead of others still waiting for an MRI? That would seem to be their expectation. It is far more serious than the person who pulls out of a long line of traffic, travels down the shoulder of the road and wants back in the line further down the road. We all know how we love to hate these people. Therefore it should bother us far more when it happens in health care.
The Government of Alberta has moved away from the policy at great cost. Alberta was forced to repay patients for medically-necessary MRI scans that were in contravention of the Canada Health Act, and moved virtually all MRI and CT services back into the public system. Alberta has since built public MRI capacity and cracked down on the practice of extra-billing. The government of Saskatchewan should look to other provinces and learn from their experience in exploring this decision. According to the Canadian Institute of Health Information Saskatchewan wait times range from 28 days to 88 days in 2013. Alberta ranges from 80 days to 247 days – the worst of the six provinces reporting.
Experience in other provinces, notably Ontario and Manitoba, is that the private clinics will poach technicians, other support staff and radiologists. Studies show that this actually increased wait times, rather than reducing them. You have stated that this will not be allowed. It is difficult to imagine how this will be accomplished. People cannot be prevented from taking jobs in the private sector just because the currently work in the public sector.
The Edmonton Journal reported on October 21, 2014 reported that a provincial audit of a private MRI clinic, which opened in May 2012, found “there is not a clear distinction between (publicly) insured and uninsured services,” an internal government email shows. The review found “concerns with access to insured services, extra billing and some documentation issues.” This highlights the problems a government must face in offering a private operator into our health care system. The additional cost of licencing and policing these operations must be considered before implementation. They are not inconsiderable.
The average cost of an MRI in for-profit private clinics in Canada is in excess of $800.00. The average cost in the public system is $250.00. Once the for-profit clinic becomes established they (and their patients) will demand that the government pay for the MRI scans and the private operators will cost us more. We have seen this happen before. We are familiar in this province of this happening previously with physiotherapy services. Private physiotherapists persuaded the government that they should be paid for providing services to patients who would otherwise have received those services from the public system. We learned two lessons from this. The private sector will most certainly poach from the public system and the contracts with the private sector proved to be terribly expensive.
One might argue that the private operators have higher costs due to the cost associated with the purchase (or rent) of the MRI machine. And it is true that the cost to the public purse may be considerably less as health foundations provide significant funds for medical technology. However if the government agrees to pay the private operators a fee similar to the public costs and then add re-imbursements for the capital costs we are in danger of discouraging further donations from the public.
Another initiative you might consider is to study the reasons for and effects of MRIs. This might be something the Health Quality Council could look at. Studies have shown that many MRIs have no effect on treatment and in fact are a redundant procedure in many cases. Perhaps applying a more evidence-based approach to MRI use would have a very beneficial effect on the wait lists and prevent needless radiation exposure to many patients.
In spite of showing good progress in reducing wait times in surgical and diagnostic procedures, you are flirting with introducing a system that has proved to not work in other jurisdictions. You have a choice. You can continue to strengthen our public health care system or you can venture forth on a venture that is extremely risky and put Canada’s favorite social program at risk. When you have had so much success at reducing wait times, it is difficult to understand why he would risk something so important.
Thank you for considering our point of view.
President, Saskatchewan Health Coalition