What we haven’t heard about the pri­va­ti­za­tion of di­ag­nos­tic test­ing and other health-care ser­vices

The Southwest Booster - - OPINION - BY BAR­BARA CAPE

Premier Wall’s re­cent mus­ing about pri­vate for-profit op­tions for MRIs in Saskatchew­an led to a flurry of pub­lic com­men­tary and a pre­dictable throne speech on Oc­to­ber 22. There are cer­tainly prob­lems with timely ac­cess to MRIs and other di­ag­nos­tic tests in Saskatchew­an, but pa­tients and vot­ers need to have ac­cess to fac­tual in­for­ma­tion that will en­able them to make fully in­formed choices about how best to re­spond to th­ese chal­lenges. Un­for­tu­nately, Premier Wall has not shared a key fact with the peo­ple of Saskatchew­an: the pub­lic sys­tem pro­vides a great deal for their health care dol­lars.

It is im­por­tant to un­der- stand how the pub­lic sec­tor re­ceives fund­ing for the di­ag­nos­tic tests they per­form. Each depart­ment in a hos­pi­tal re­ceives an an­nual bud­get based mainly on the amount of staff, sup­plies, and equip­ment re­quired to de­liver the nor­mal level of ser­vice or num­ber of pro­ce­dures to the com­mu­nity. But what if the com­mu­nity’s need for ser­vices that year turned out to be higher than nor­mal? What if, to meet that need, the depart­ment ran hun­dreds of ad­di­tional tests? When this oc­curs, they get NO ex­tra fund­ing. And this has oc­curred in Saskatchew­an. Ac­cord­ing to the Cana­dian In­sti­tute for Health In­for­ma­tion, Saskatchew­an’s pub­lic sec­tor per­formed 21,814 MRI scans in the year 2006-07. Five years later that num­ber had almost dou­bled, to 42,069. This rise was pre- dictable given Saskatchew­an’s grow­ing and ag­ing pop­u­la­tion. How­ever, the pub­lic sec­tor bud­get to per­form th­ese tests was not given a cor­re­spond­ing in­crease; the gov­ern­ment ex­pected hos­pi­tals to ab­sorb the in­creased vol­ume by do­ing more with less, for ex­am­ple by not filling va­cant po­si­tions and forced re­duc­tions in sick time, over­time and WCB ben­e­fits.

When the pri­vate for­profit providers en­ter the pic­ture, you need to know that they re­ceive fund­ing for ev­ery sin­gle test per­formed and in most cases per­form quite rou­tine test­ing at a much higher cost. The 2012 study done by D. Gib­son, ‘De­liv­ery Mat­ters: The High Cost of For-Profit Health Ser­vices in Al­berta’ con­firmed that pri­vate surg­eries cost be­tween seven to 30 per cent more per pro­ce­dure than the pub­lic sys­tem. This in­crease can rea­son­ably be ex­tended beyond surg­eries to the pro­vi­sion of MRIs.

The pro­fes­sion­als who per­form and in­ter­pret MRIs and other di­ag­nos­tic tests are a limited and valu­able re­source. Train­ing or at­tract­ing more of them is not quick, cheap, or easy. In­evitably, when the for­profit provider sets up shop, the first thing they will try to do is to poach staff from the al­ready un­der­staffed pub­lic sec­tor. This cre­ates a down­ward spi­ral: the pub­lic sys­tem be­comes fur­ther de­pleted, and less able to meet grow­ing pa­tient needs, while pa­tients and fam­i­lies must pay more and out-of-pocket to ac­cess the pri­vate for­profit provider. As Dr. Paul Babyn so per­sua­sively stated on Oc­to­ber 21, “it is im­por­tant not to dam­age the health care sys­tem the prov­ince has spent a long time to cre­ate.” He noted that pri­vate MRIs do not and should not di­min­ish the need to im­prove our pub­lic pro­vi­sion of MRIs. Based on Cana­dian av­er­ages Saskatchew­an should have at least nine pub­lic MRIs; it cur­rently has just six. Our cur­rent prob­lem is ul­ti­mately caused by gov­ern­ment fail­ing to pro­vide the pub­lic health care sec­tor with the fi­nan­cial and hu­man re­sources needed to meet pre­dictable in­creases in need.

We re­ally do need to be care­ful and con­sider the long-term ef­fects of our decision-mak­ing – do we re­ally want an Amer­i­canstyle health care sys­tem where the poor have se­verely limited op­tions and the rich have ac­cess to bou­tique health­care? I think not. Rather, I think we need to invest in a health care sys­tem that can keep up with the ob­vi­ous in­crease in vol­umes. Let’s fund the pub­lic sec­tor with the needed re­sources to do so. Be­fore we en­ter­tain pri­vate MRI’s, let’s con­sider bet­ter uti­liz­ing our cur­rent sys­tem through im­proved staffing lev­els to ad­dress our crit­i­cal ser­vice needs and in­creas­ing the num­ber of our MRI’s to na­tional stan­dards to build in­ter­nal ca­pac­ity that meets our de­mand. Our prov­ince has adopted a LEAN method­ol­ogy for health­care de­liv­ery, let’s look to that ex­am­ple of build­ing our ca­pac­ity to de­liver that ser­vice, in­stead of adopt­ing the at­ti­tude of “It’s too hard” or “we can’t do it.” We can – if given ad­e­quate tools, re­sources and op­por­tu­nity.

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