Why private MRI clinics aren’t the answer to long wait times

by Gregory Beatty

based on a photo by Jan Ainali

provinceThroughout his seven-year premiership, Brad Wall has often floated trial balloons on contentious policy issues. Privatizing publicly-owned liquor stores, boosting the education portion of property taxes to pay for infrastructure, and building small-scale nuclear power plants are three examples of Wall testing out an idea by talking about it publicly without committing to it.

During an Oct. 16 appearance on John Gormley Live, Wall blew his soap bubble, musing about allowing private magnetic resonance imaging (MRI) clinics where people could pay out of pocket for scans — which doctors use as a diagnostic tool for a wide variety of conditions including cancer, dementia, epilepsy and heart disease.

A few days later he addressed the subject again in a pre-Throne Speech scrum, where he told reporters he expected debate on the idea in the Legislature during the fall session.

“It’s a discussion that many in the province are willing to have,” says NDP opposition leader Cam Broten. “My goal is to have a health care system that’s the best for everyone.

“The status quo isn’t satisfactory. We need a better level of care,” says Broten. “But the answer is not in providing an option where those who have a spare thousand dollars can pay to receive an MRI and then jump the line in order to get the surgery they need.

“What I want to see is improvement throughout the entire system so that we have better care for everyone, not just those who can afford it,” he says.

Private clinics are a growing presence in Saskatchewan. In fact, on Oct. 20, Mayfair Diagnostics opened a private MRI clinic in Regina. Other clinics perform day surgeries, X-rays, ultrasounds, CT scans and whatnot. The costs are covered under Medicare, and after being referred by a physician, you’re put on a wait list to receive the test or procedure.

The user-pay clinics that Wall is touting are an entirely different animal. Patients would be free to pay the clinic directly, and thus avoid the public wait list. Wall’s main selling point was that private MRI clinics would take pressure off publicly-funded clinics, and shorten wait times for everyone.

But critics charge that the proposal would lead to two-tier Medicare and hurt the long-term health of many Saskatchewan residents.

“At first you might think ‘Oh, yeah, if we have another option it might shorten the wait list’,” says Ryan Meili, the vice-chair of Canadian Doctors For Medicare. “But in Alberta, the private facilities draw resources away from the public system, so they have significantly longer wait times. In Saskatchewan, the average wait for an MRI is 28 days with some waiting as long as 88 days. In Alberta, the average is 87 days with some waiting up to 247 days.”

When Manitoba introduced patient pay cataract surgery, Meili adds, “what they discovered was rather than shortening the wait list by taking those patients who could pay out, it actually lengthened the wait list because it also took surgeons and facilities out of the public system.”

Wall counters that argument by saying private clinics wouldn’t be allowed to poach public sector health care workers.

“I’m pretty skeptical about that,” says Meili. “Not because I don’t think he’s got good intentions, but because nobody has done it. There’s no system in the world that’s been able to create a firewall to keep people from making that shift. Where attempts are made, when you go back later you find that people find ways of spending more time in the parts of the system that are more lucrative.”

Meili suspects that over-use is another cause of longer wait times in Alberta.

“There are studies that show about half of MRIs ordered there shouldn’t be ordered,” he says. “That kind of culture can be contributed to by the idea that you can just pay for an MRI whenever you want one.”

In Saskatchewan, physicians act as gate-keepers, ensuring people only get costly tests and other procedures when medically necessary.

Not only do private pay clinics enable people (at least those who can afford it) to skip the line-up for the publicly-funded service, once they have their MRI they can jump back into the public system, and get in line for treatment ahead of those still waiting for their publicly-funded MRI.

“It’s been shown in Alberta,” says Meili. “Patients who pay not only get their MRI faster, but then they go back into the public waiting list with information that allows them to get their surgery more quickly. So they’re able to collect on the public investment faster than those who can’t afford a private MRI.”

Are private pay clinics the thin edge of a wedge leading to more privatization?

“I’d say this is actually the thicker edge of the wedge because it’s patients paying directly for a procedure,” says Meili. “So you have people saying, ‘I don’t have confidence I can get what I need from the public system so I’m going to spend money out of my pocket.’ What does that do to their desire to contribute through their taxes to the collective investment in the public system?”

As health care practitioners, Meili and his organization are strong advocates for getting the best bang for our health care dollar — which in Saskatchewan amounted to more than $6 billion in provincial and federal money in 2014-15.

“We need to have the ability to respond to illness, of course,” he says. “But we also need to invest in keeping people healthy. We need fewer expensive imaging tests and surgeries, and fewer people on medications because they actually lead healthy lives.”

When Wall floated his balloon about patient pay clinics in Saskatchewan, Meili says, he talked about Alberta’s example. “But it’s been over a decade since a new private MRI facility was built there, because they realized it just wasn’t helping. Instead, they’ve been increasing capacity in the public system. So rather than looking at Alberta 10 years ago, we need to look at Alberta now, and figure out ways to strengthen the public system through innovation rather than undermining it.”