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