November 4, 2014
Premier Brad Wall
Dear Premier Wall:
Thank you for your letter of October 29, 2014 with respect to private MRI’s. We appreciate that the government has not yet made a decision on allowing private pay-as-you-go MRI’s in our province. As stated in our letter of October 27, 2014 we believe that the introduction of private MRI’s would be a threat to our public health care system, they simply have not worked in other provinces to shorten waiting lists, and they will poach scarce workers from the public system.
Further to your letter I would offer the following comments. As the former CEO of the Prince Albert Health District, I know that governments tend to fund the contracts with the private sector at a much richer rate than how they fund the public sector. I recall an incident where a small foundation based in one of our nearby towns raised $50,000 to purchase a piece of diagnostic imaging equipment. This was not a large foundation running million dollar house lotteries, but rather a group of people in a small community holding bake sales. When the donation was made to the PAHD, one of the reporters asked a radiologist how valuable the piece of equipment would be. The reply was “Very valuable, in fact I think we will purchase one of these machines for our private practice.” I was clear that the private practice billing fee-for-service could afford to purchase this equipment as they would be reimbursed for the cost of the machine through the fee-for-service billing.
You state in your letter that “Since 2008, 61 pieces of aging medical imaging equipment have been replaced.” How much of the cost of replacing this equipment has been provided by the provincial government and how much was through local contributions? By moving more and more to private contractors we are in danger of losing the valuable contributions from our local communities.
I offer you another example of how the public sector can respond when it has the capacity to do so. When the current Victoria Hospital in Prince Albert was built in 1973, it was designed to offer regional laboratory services. However, shortly after the construction a private pathologist billing fee-for-service set up shop in Prince Albert. Shortly after the establishment of the Prince Albert Health District the provincial government asked how much it would cost to provide the services that were being provided by the private pathologist. The answer was somewhere in the range of $600,000 annually. The answer was based on the fact that the public laboratory had been built to service this volume and with only the addition of one piece of equipment and extra staff the public laboratory was able to handle the laboratory tests at a cost that was nearly one-half of what the private pathologist was providing them for. This clearly illustrates that if the government provides the capacity in the public system, the public system can respond efficiently and effectively.
The PAHD also responded in a similar manner when it was made responsible for administering government contracts for physiotherapy services with private physiotherapists. Cancelling those contracts and expanding the number of physiotherapists in the public sector resulted in similar results to the laboratory example given above. The main problem that occurred in this case was that of poaching by the private physiotherapists as they were still able to offer private pay-as-you go services.
We think that these two examples provide ample proof that allowing private pay-as-you-go MRI services is a threat to the public system, and will end up being more costly in the long run.
Your letter also mentions that MRI scans have increased by 88% (time frame not mentioned). We reiterate our concern that such an increase is warranted and suggest that the government take a look at whether or not this increase can be justified from a clinical perspective. There is true value in pursuing an evidence-based approach to all diagnostic procedures.
We thank you for your consideration of our position.
President, Saskatchewan Health Coalition