Today, a council debate over MRI and CT scans is taking place in Edmonton, Canada, that shows the stark difference between the U.S. and Canadian healthcare systems. While recent reforms in the U.S. have attempted to bring care to those left behind by a system consisting largely of private insurance and delivery, a medical watchdog group in Alberta wants the province to ban privately-paid MRI and CT scans altogether.
The College of Physicians and Surgeons of Alberta (CPSA), which regulates doctors in the province, sparked the debate last week by saying patients who can afford diagnostic tests on their own without waiting for a publicly-funded test are essentially jumping the line for care, according to the Calgary Herald. Their stance is that access to care should be based on medical need, not the ability to pay, and that doctors should also not be able to terminate relationships with current patients who can’t pay the fees.
Opponents of the private MRI ban argue that forcing more people to receive publicly-funded diagnostic tests will only increase already lengthy wait times. Under the Canadian system, top-priority scans are performed within a matter of days, but cases deemed non-urgent can leave patients waiting months before they are placed in a scanner.
If CPSA’s council approves the changes to the standard of practice at today’s meeting, there will be a two month comment period before the rules get final approval, according to the Calgary Herald.
What can providers here in the U.S. learn from this episode? If the contentious debates over the Accountable Care Act are any indication, there’s no risk of a major push to ban private imaging any time soon. But the U.S. medical imaging community should look at the lead-up to CPSA’s proposal and appreciate the role inappropriate imaging may have played.
Take MRI for low back pain, the poster child for imaging that may be inappropriate. A study published earlier this year in JAMA Internal Medicine found that more than half of the requested MRIs for lower back pain in Alberta’s health system were either inappropriate or provided uncertain value for the patient.
It stands to reason that removing scans that don’t meet appropriateness criteria would also cut down on wait times, and thus reduce the need for radical interventions like a ban on privately-paid MRI or CT scans. Such a ban may not be on the radar in the U.S., but the debate in Canada should be just another reminder that the imaging community should take appropriate utilization very seriously.
Editor – Health Imaging