Private MRIs wrong prescription - Infomart - 0 views
www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|relp|20151026|232213388
from heather diagnostics private clinics privatization Saskatchewan
shared by Govind Rao on 26 Oct 15
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The Leader-Post (Regina) Mon Oct 26 2015
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In the final sitting of the legislature before the spring election, Premier Brad Wall's government plans to pass Bill 179 to facilitate private user-pay MRIs in Saskatchewan. As a longtime family doctor, I see this as a cynical political move that caters to public fears about long wait lists for imaging, but which will actually work to make things worse for patients who truly need an MRI.
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There is very clear evidence that, far from relieving pressures in the public system, offering a separate stream for the wealthy to jump the queue actually lengthens public wait lists. This has been shown over and over again, whether it be with cataract surgery, diagnostic imaging or surgical procedures. MRI is no different.
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In Alberta, where private MRI facilities advertise and operate, the median wait time for an MRI is much longer (80 days) than in Saskatchewan (28 days). Furthermore, the wait has lengthened in the public system in Alberta since privatized facilities came on the scene. The explanations are complex, but siphoning human capacity (doctors and technologists), as well as other resources, from the public system into the private and more lucrative stream plays a big role. So does the market generation of increased demand by deceptive advertising and promotion of privatized services.
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Medical tests should be ordered in accordance with evidence-based guidelines about their usefulness and indications. Patient access to MRI is currently prioritized in Saskatchewan health-care facilities on the basis of medical need, from Level I (a life-threatening diagnosis or treatment requiring MRI within 24 hours) to a Level IV (stable patients needing long range diagnosis or management allowing for delay of 30-90 days).
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This system works and prioritizes appropriately. While patients sometimes feel that an urgent MRI will make a difference to their outcome, this is rarely the case. When it is the case, patients are prioritized and get urgent access. Allowing private MRI's based on ability to pay and jump the queue will trample this well-developed, equitable system. It will allow the wealthy or anxious to bypass this system and result in two-tiered care.
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We live in a society obsessed with health. Selling fear of sickness is profitable. But access to MRIs is not our most urgent health-care need. To suggest otherwise is to obscure the social and economic determinants that define who is healthy and who is not, and to further shift resources away from the sick towards the worried well.
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The Wall government and the private MRI operators that will profit from this legislation have proposed a two-for-one deal, suggesting that one public MRI scan will be done for every private MRI performed. Don't be fooled. This will not get around the problem of prolonging public wait lists since it will siphon resources from the public system. If we really need more MRIs, why not increase capacity in the public system instead?
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While MRI can be a useful tool, when inappropriately used it can lead to overdiagnosis or "false positives." This then triggers a costly cascade of subsequent investigations or interventions to reassure either physician or patient MRI technology has important limitations, and frequently finds unrelated non-significant abnormalities that frighten patients. For example, 90 per cent of healthy individuals over 60 years of age with no symptoms of back pain show degenerative abnormalities on MRI. Similarly, the vast majority of adults over 50 show knee damage on MRI and only clinical assessment by a doctor identifies whether or not these findings are significant. Early MRI has not been shown to improve outcomes in low back pain and may actually make for worse outcomes. A doctor examining for red flag symptoms can identify the very small number of patients for whom an MRI is useful.
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Many MRI scans are therefore unnecessary. Allowing patients to purchase an investigation they don't need wastes resources, bypasses the role of an informed health-care provider, and may in the end actually harm patients with needless investigations and interventions. Physicians are engaged in initiatives to "choose wisely" in testing. Throwing the door open to investigations based on ability to pay, rather than medical need, flies in the face of sensible approaches to health resources.
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And the queue-jumping is not just limited to getting an MRI. It will extend to preferential and quicker access to treatment options, such as specialist care and surgery based on the MRI results if positive.
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Let's promote greater equity, not less, and preserve health care based on need, not two-tiered care based on ability to pay. Let's trust health-care providers to counsel patients about the right test at the right time and to prioritize patients appropriately. The marketplace has no role in these decisions.
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Dr. Sally Mahood is a Regina family doctor and an associate professor, Family Medicine, University of Saskatchewan.