Private MRIs in SK? Get back in Line, Mr. Premier

Private MRIs in SK? Get back in Line, Mr. Premier

Postby Oscar » Sun Oct 19, 2014 3:56 pm

Playing MRI Politics With The Health Of Saskatchewan's People

[ http://canadians.org/blog/playing-mri-p ... ans-people ]

by Michael Butler, Health Care Campaigner, Council of Canadians

October 17, 2014 - 10:18pm

110 years ago this month, the man who would lead the fight to bring public Medicare to all Canadians was born. Tommy Douglas, Canada’s greatest Canadian, had a fundamental belief that health care should be provided equitably to people based on need and not ability to pay. Unfortunately, today we have a premier of Saskatchewan – Brad Wall – who is considering introducing a two-tier and pay-per-use MRI service - i.e. one system for those who can pay and one for the rest of us.

Let’s be clear; what Brad Wall is talking about is queue jumping for the rich and further stepping away from universal, publicly funded health care for the people in Saskatchewan. Perhaps this isn’t surprising as Brad Wall continues to not seriously push his friend Stephen Harper to renegotiation a Health Accord ($100 million more in costs and risks every year over the next 10 years in Saskatchewan, or to put it another way, $1.1 billion less for Saskatchewan health care). [ http://www.newstalk650.com/story/feds-u ... ces/299254 ] This government is planning a new P3 hospital in North Battleford full of hidden costs (and likely large expense overruns) which will end up costing our public system resources that should be going to patients. [ http://www.canadians.org/event/maude-ba ... are-public ] Lastly, this is the same Brad Wall who said in 2009 that, “his government’s health reforms would not allow anyone ‘to use a bulging wallet to jump the queue’”. [ http://behindthenumbers.ca/2014/10/17/g ... r-premier/ ]

Back to private MRI services in Saskatchewan. As we speak, it is being reported by a health ministry spokesperson, “an unnamed company has applied to have a diagnostic imaging centre licensed in Saskatchewan, and that the application is under review. The ministry won't release the identity of the company, or say when it filed the application”. It is no surprise then that the Premier is speaking to the media as a pitch man for the interests of these private companies and spreading myths. [ http://www.thestarphoenix.com/health/Sa ... story.html ]

Yet, we know that when you have a two-tiered system with private clinics for the rich, it makes staff shortages even worse as health professionals are poached from the public system. [ http://web.net/ohc/docs/rossreport.htm ] Moreover, with private MRI clinics, we have seen that they are located in urban centres (where the wealthiest clients are), removing scarce health care professionals, capacity and funding from rural areas. These clinics are not interested in access to care for patient or health equity; they are located where they can make the most money in large cities. And while Wall has said companies would not be allowed to poach workers from the public health care system, it is amazing he could keep a straight face while lying through his teeth. [ http://www.thestarphoenix.com/health/Sa ... story.html ] It is preposterous to say that the Saskatchewan government can legally, or would, enforce private companies not hiring workers from the public sector.

As well, let’s dispel the myth that more machines does not necessarily equal shorter wait times (correlation does always equal causation). The limited number of technicians to run the machines is a serious factor which increases wait times. Investing in human capital for public health care - which in the absence of a renegotiated Health Accord is increasingly difficult for provinces – is an issue we can’t ignore and perhaps a place the Saskatchewan government could put some focus. We only have to look as far as Ontario and Manitoba where studies have shown that the introduction of private clinics for MRIs increased wait times in local public hospitals because they poached scarce technologists and radiologists; this reduced the number of hours that the local public hospitals' MRIs could operate. [ http://web.net/ohc/Eroding%20Public%20Medicare.pdf ] When Alberta introduced their private MRIs, it is has been highlighted that one Calgary hospital lost three of five diagnostic technologists to a new MRI clinic that offered signing bonuses of up to $10,000. [http://behindthenumbers.ca/2014/10/17/get-back-in-line-mr-premier/ ] Similar pressures are being reported in Nova Scotia and technologists and radiologists working in Ontario’s hospitals are already being approached by companies hoping to open up private clinics.

So, what about wait times? Perhaps the biggest myth proponents of two-tier health care spin are that it reduces wait times. This pay-per-use model of care for the rich has been shown in study [ http://web.net/ohc/docs/rossreport.htm ] after study [ http://medicare.ca/main/the-facts/wait- ... -and-cures ] to increase wait times for the majority of patients (the ordinary people in Saskatchewan). It is telling that when this is pointed out, the pro-privatization crowd takes to twitters and pulls out slogans and ad hominem attacks saying you’re ‘anti-progress’ or ‘a communist’ and so on... We need to talk about real solutions to wait times, which are out there and being implemented as we speak. There are places to improve and new solutions that do need to be implemented: these solutions involve us protecting, strengthening, and expanding out public medicare. For example, Gordon Campbell, President of CUPE Saskatchewan’s Health Care Council has explained that, “In the last 12 years, MRI waitlists have gone from 22 months to 3 months, so we are obviously doing something right... We need to keep investing in public solutions.” [ https://cupe.ca/public-options-health-c ... -says-cupe ]

At the same time that Brad Wall is pointing to Alberta as the promise land for MRI wait times, it has been pointed out that, “while Premier Wall is looking to Alberta as an example, the Government of Alberta has moved away from the policy at great cost. Alberta was forced to repay patients for medically-necessary MRI scans that were in contravention of the Canada Health Act, and moved virtually all MRI and CT services back into the public system. Alberta has since built public MRI capacity and cracked down on the practice of extra-billing. The government of Saskatchewan should look to other provinces and learn from their experience in exploring this decision.” [ http://www.canadiandoctorsformedicare.c ... Itemid=172 ] The evidence is quite clear in this case, unfortunately the Saskatchewan government seems to be more interested in playing political games than finding real solutions and innovations for better health outcomes.

Moreover, the CCPA recently outlined that, “According to the Canadian Institute for Health Information, Saskatchewan posted typical waiting times for MRIs at 28 days. [ https://secure.cihi.ca/free_products/20 ... AiB_EN.pdf ] Whereas in Alberta, even with pay-for-service private clinics, typical wait times for a MRI scan was 80 days... the Alberta experience with pay-for-private clinics has devolved into a litany of queue-jumping and preferential access to such an extent that it is undermining public confidence in the health system. [ http://www.macleans.ca/news/canada/inqu ... changes-2/ ] The College of Physicians and Surgeons of Alberta has proposed to ban private imaging diagnostic clinics altogether because of the damage it is doing to the public system in that province. [ http://www2.canada.com/edmontonjournal/ ... 407c2b5130 ] The Saskatchewan government is aware of these figures and that privatizing MRIs in the province will lead to diminished public health care for the people of Saskatchewan, but as is often the case with the Wall government, this is about dirty politics and not the needs of people.

We do face many challenges to our public health care system as populations and their needs change. And, it is understandable that, when faced with a health issue, people want quick and quality care, who wouldn’t? But, even a cursory look at the results of private MRI clinics in Canada and the research done on two-tiered health services shows that this privateering hurts the majority of us, and reduces the speed and quality of care we receive. Again, there are challenges, but there are also public solutions to address problems that maintain a medicare system based on equity and need. To play politics with our health while spinning lies and rhetoric in the media is both is unconscionable and repulsive. The people of Saskatchewan deserve better.

Michael Butler < mbutler@canadians.org >
Michael Butler, Health Campaigner
Council of Canadians
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Re: Playing MRI Politics With The Health Of Saskatchewan's P

Postby Oscar » Sun Oct 19, 2014 4:24 pm

Get back in line, Mr. Premier

[ http://behindthenumbers.ca/2014/10/17/g ... r-premier/ ]

October 17th, 2014 Simon Enoch · No Comments · Health Care, Saskatchewan, Uncategorized

Saskatchewan Premier Brad Wall once again stirred the privatization pot yesterday when he took to social media to ask: “Is it time to allow people to pay for their own private MRI’s in Saskatchewan like they can do in Alberta?” The Premier’s twitter trial balloon suggests the government will argue that allowing private, for-profit MRIs will help reduce wait times in the public system. The Premier himself added: “It does make sense that the wait list is going to shrink because those who want to pay will come off that public wait list and they’ll get their MRIs and thereby shortening the wait list for all, whether they want to pay or not.”

This certainly is a rather radical re-direction for the Saskatchewan government on the healthcare front. While always a champion of private, for-profit clinics, the government has always been at pains to reassure the public that these experiments with private healthcare would always remain within the ambit of the public system – paid for by public dollars and used to relieve stresses on the public system. Indeed, faced with the question of a proposed private MRI centre in 2008, the Premier “said offering medical services such as an MRI for a fee “seems to be outside the Canada Health Act,” and is area where the government doesn’t want to tread.” Moreover, government officials “said patients would not be able to jump to the front of the queue by paying out-of-pocket, but rather that the proposed centre would work with the existing system.” Indeed, Mr. Wall has made the queue-jumping promise himself, telling reporters in 2009 that his government’s health reforms would not allow anyone “to use a bulging wallet to jump the queue.” In light of this history, Mr. Wall’s about-face is surprising, particularly given this government’s historic vulnerability on the privatization question.

Notwithstanding Mr. Wall’s rather abrupt reversal on this issue, the threat of private MRI clinics to our public system is very real but maybe not readily apparent. So let’s take a look at why one might oppose the establishment of private-pay-for-access MRI clinics in Saskatchewan.

First of all, as the Premier rightly observed in 2008, private pay-for MRIs undermine the accessibility criterion of the Canada Health Act which states that “access to medically necessary services should be based on need – not on means – and on uniform terms and conditions.” Persons who have the ability to purchase private MRIs end up getting faster access to health services in two ways: First of all, they gain access to the test itself. Secondly, they can then return to the publicly funded system for treatment, should such care be required, one step ahead of patients still waiting to obtain publicly funded diagnostic tests.

But it’s not just that those people who can afford it gain access to quicker care. Those of us who cannot afford to purchase private MRIs may see our access undermined. For example, there is the very real problem that if for-profit clinics are opened they will have to steal staff from the public system, making it harder for the public system to operate efficiently. There is considerable anecdotal evidence to support this position. As the Ontario Health Coalition reports:

One Calgary hospital lost three of five diagnostic technologists to a new MRI clinic that offered signing bonuses of up to $10,000. Similar pressures are being reported in Nova Scotia and technologists and radiologists working in Ontario’s hospitals are already being approached by companies hoping to open up private clinics. The question of how these clinics are to be staffed has already been raised by the Ontario Association of Radiologists which says the system could currently use an extra 150 professionals. Even the Saskatchewan Ministry of Health is concerned about losing staff to Ontario if the 20 for-profit clinics open…Dr. Normand Laberge, president of the Canadian Association of Radiologists, suggested that private clinics may exacerbate the problem of waiting lines. In his view, governments may assume that the private clinics will “solve the problem” rather than governments being proactive and taking the steps necessary to provide timely access to needed diagnostic services.

Moreover, if the Saskatchewan government believes that emulating Alberta’s private model will “solve” our wait-list problems, it may be in for a surprise. According to the Canadian Institute for Health Information, Saskatchewan posted typical waiting times for MRIs at 28 days. Whereas in Alberta, even with pay-for-service private clinics, typical wait times for a MRI scan was 80 days. Moreover, the Alberta experience with pay-for-private clinics has devolved into a litany of queue-jumping and preferential access to such an extent that it is undermining public confidence in the health system. Indeed the College of Physicians and Surgeons of Alberta has proposed to ban private imaging diagnostic clinics altogether because of the damage it is doing to the public system in that province. This would not seem to be an experience that any province should be eager to match. So rather than follow Alberta’s lead, how about we invest in greater capacity and more efficient utilization of MRIs in our current public system?

Now if only the Premier would ask us that question….

Simon Enoch is Director of the Saskatchewan Office of the Canadian Centre for Policy Alternatives.

The above quotes from Premier Brad Wall are taken from the following newspaper articles:

“Proposed MRI project renews privatization debate.” by Angela Hall. Leader Post 15 Feb 2008: A3.

“Wall puts philosophical stamp on Saskatchewan Party policy.” by Murray Mandryk. Leader Post 23 Oct 2009: B.11.
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Re: Private MRIs in SK? Get back in Line, Mr. Premier

Postby Oscar » Fri Jun 19, 2015 4:55 pm

MRI privatization not the answer

[ http://www.yorktonnews.com/opinion/edit ... -1.1639991 ]

by Dr. Ryan Meili Yorkton News Review October 30, 2014 02:00 AM

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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Re: Private MRIs in SK? Get back in Line, Mr. Premier

Postby Oscar » Sun Jun 19, 2016 9:06 pm

Fighting privatization in the heartland of medicare

[ http://canadians.org/blog/fighting-priv ... d-medicare ]

September 21, 2015 – 11:03 pm

Last week the Council of Canadians and CUPE Saskatchewan conducted a five city tour [ http://canadians.org/blog/council-canad ... des-regina ] to raise awareness about the increasing privatization of public health care in the province. Sadly, we are seeing, “increased creeping privatization" in the heartland of medicare. [ http://rankandfile.ca/2015/09/16/saskat ... el-butler/ ] Brad Wall has been behind backdoor cuts and policy and legislative changes. The founding principle of medicare – need and universality – is being eroded.

People from across Saskatchewan explained why public health care matters so much to them. In Prince Albert, CUPE Saskatchewan president Tom Graham highlighted that medicare is “something we should be preserving – not selling off... It started in this province and it needs to carry on. We can’t be having private surgeries, private MRIs, private laundry, private food services; who knows what’s next?” [ http://www.paherald.sk.ca/News/Local/20 ... rdquo%3B/1 ]

In Yorkton, we heard about how hospital laundry services, and the jobs in the community that they provide, have been contracted out to Alberta. Audience members shared stories of how laundry is coming back unfolded, moldy and even with blood stains still on them. In North Battleford the audience told us that the process for the P3 prison/hospital complex has been nothing but a boondoggle; locals questioned the competence of those in charge of the project (prior to the 2011 election, the provincial government priced the new building at $100 million but recent estimates have already ballooned to $175 - 250 million).

In Weyburn, the epicenter of medicare in Canada, we heard a disturbing story from an audience member about how her grandmother, before medicare, had to sell her cow to get enough money for cancer treatment. If it wasn’t for neighbours who offered to share their cow’s milk with her children, she would not have been able to pay for treatment. While times have changed, the audience member highlighted no one should ever be put in the position where ability to pay comes before need. Lastly, in Regina we heard how the provincial government refused to vote for legislation to make P3 deals more transparent and accountable, preferring to keep the terms of the deals to themselves.

With the federal government walking away from its responsibility to provide quality health care to Canadians, people were concerned that provinces are facing a difficult situation. Without a renegotiated Health Accord, health funding will receive only $43.5 billion over eight years. In Saskatchewan, the cumulative projected loss is $1.37 billion and already (from March 2014-2015) the province has seen a loss of $33.2 million due to changes in the equalization formula for the Canadian Health Transfer. While this situation creates challenges, instead of showing leadership the Saskatchewan government is following in the footsteps of the Harper government and putting ideology ahead of fairness. Across the province, we heard from people who questioned how after "8 year of prosperity" in Saskatchewan there was so little to show for it.

In every city we visited people were fed up with the rhetoric and fictions coming from the Brad Wall government. The recent changes to legislation to bring in private pay-for-service MRI scans isn’t about better care or decreasing wait times. It is about smuggling in a two-tiered US style private health care into the province. The result will be queue jumping for the wealthy. This inequitable system is being proposed by the same Premier Wall who said in 2009 that, “his government’s health reforms will not allow anyone "to use a bulging wallet to jump the queue." [ http://behindthenumbers.ca/2014/10/17/g ... r-premier/ ]

While wait times are an important issue to address, this government seems to have learned little from other provinces that brought in private MRIs and saw their wait times increase. This model of care has been shown in study [ http://www.ontariohealthcoalition.ca/ ] after study [ http://medicare.ca/main/the-facts/wait- ... -and-cures ] to increase wait times for the majority of patients. There are a limited number of technicians to work the machines, and when private clinics enter into the equation they poach workers from the public system. For example, when Alberta introduced private MRIs, one Calgary hospital lost three of five diagnostic technologists to a new MRI clinic that offered large signing bonuses. According to the Canadian Institute for Health Information [ https://secure.cihi.ca/free_products/20 ... AiB_EN.pdf ], Saskatchewan's wait times for MRIs are around 28 days, a typical number for public hospitals. Whereas in Alberta, where pay-for-service private clinics proliferate, wait times for an MRI scan is 80 days. These waiting lists exist despite Alberta having the second highest number of scanners per capita in the country. After introducing pay-per-use imaging to address wait times, the Government of Alberta moved away from the policy at great cost.

Along with resource drift from the public system and lengthening wait times, there are no financial savings to the hybrid system and no increase in accessibility. In fact, there is actually no real evidence for provinces to promote patient-pay imaging centres. It simply takes government off the hook as it pretends to be doing something - it doesn’t have to invest in the public system, but in health care privateers. This is a step backwards that defies common sense. Everywhere we spoke, people were outraged that the Saskatchewan government is putting ideology and rhetoric ahead of evidence and fairness.

Another place quality public health care is being weakened in Saskatchewan is in the use of public private partnerships (P3s). These "deals" are a waste of public money that should be invested in services. There is no health policy or business case for P3s; study after study demonstrates that P3 hospitals and health services cost more, are less transparent, and are not accountable. In addition to expensive financing and construction costs, P3 hospital deals often include hidden privatized services such as maintenance, security, cleaning and laundry, adding tens of millions more to the final price tag and reducing health outcomes for patients. Yet, the Saskatchewan government is aggressively privatizing health services through P3 deals and building P3 hospitals.

Recently, the Saskatchewan Auditor General report on P3 showed [ https://www.policyalternatives.ca/sites ... ure_P3.pdf ] that rather than learning from the mistakes of other jurisdictions, the government is repeating them. The report found that the risk assessments, the primary means used to justify the cost effectiveness of the P3 model, were made without any empirical or historical evidence. SaskBuilds, in charge of P3 deals, has already spent $5.6 million on Partnerships BC, who provide advice on virtually all P3s in the province. Yet Partnerships BC generates all of its income by promoting P3s and providing biased advice. They have yet to suggest that the public option is better. As we heard on the tour, this is like going to buy a truck and paying a salesman to tell you that his trucks are the best.

Saskatchewan is the home of universal public health care, the heartland of Canada’s most cherished social program. When Tommy Douglas first campaigned to introduce medicare in the 1960 Saskatchewan provincial election, he had long term aspirations and integrity. His dream was visionary in scope and revolutionary in effect. The people of Saskatchewan have not forgotten what this means and are sending a clear and simple message to the government: our health care must be based on need and not the ability to pay.

Further Reading:

Council of Canadians & CUPE health care tour concludes in Regina - September 18, 2015

[ http://canadians.org/blog/council-canad ... des-regina ]

Council of Canadians and CUPE launch 5-city tour against the privatization of health care in Saskatchewan - September 14, 2015
[ http://canadians.org/blog/council-canad ... skatchewan ]

Michael Butler's blog
Health Care Campaigner for the Council of Canadians
[ http://canadians.org/blogs/michael-butler ]
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