This past week, Saskatchewan Premier Brad Wall took to twitter to ask the question "Is it time to allow people to pay for their own private MRIs in Saskatchewan like they can do in Alberta?"
His comments came after a radio show in which he'd received a call from a patient who's been waiting three months for an MRI - one of many Saskatchewan patients who are, understandably, frustrated by long waits for essential imaging services. It's a real problem. For that reason, we should be wary of false solutions, and look first to evidence before rhetoric takes over.
The best place to look for evidence is the province Wall references as a model: Alberta. Many Saskatchewan residents have sought out care in Alberta's private MRI clinics, giving the impression that the experiment there has been a success. It turns out, when we take a closer look, that things are not so rosy in the land of private MRIs after all.
Perhaps the most surprising fact is that the wait list for an MRI in Alberta, rather than having been shortened by the presence of private imaging clinics, is actually the longest in the country.
According to the Canadian Institute for Health Information (CIHI), patients in Alberta can wait from 87 days to up to 247 days compared with a 28 to 88 day wait in Saskatchewan. These waiting lists exist despite Alberta having the second highest number of scanners per capita in the country, suggesting that overuse may be a problem - a phenomenon that may actually be exacerbated by excess capacity.
More troubling yet is the question of equity. If an MRI scan is the limiting factor for getting a surgery, and I can pay for my scan, I get to have my publicly-funded surgery before someone in as much need but less able to pay out of pocket. This is the principle reason that the existence of patient-pay MRI clinics, as Wall has pointed out, is against the Canada Health Act.
Along with failing to increase affordability and access, private MRIs pose a more insidious threat to publicly-funded healthcare. The more Canadians believe that they have to pay out of their own pocket for necessary care, the more we will see confidence in and commitment to medicare eroded.
There are ways of improving access to MRI that don't undermine the principles of or confidence in the public system. Imaging is one of the most overused elements of our healthcare system. A 2013 study of MRI use in Alberta showed that over half of low back MRI scans in an Alberta hospital were not appropriate. Expanding hours of use, training programs for personnel, and the number of machines in the public system is another. Saskatchewan should look at the experiences of other provinces before choosing a path that could actually make them worse.
Ryan Meili is a family physician in Saskatoon, an expert advisor with EvidenceNetwork.ca, and vice-chair of Canadian Doctors for Medicare. @ryanmeili
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