New MRI plan a needed change to broken system

More public scans reduce waiting times, write Edith MacHattie and Rick Turner.

B.C. lags behind much of the country when it comes to MRI waiting times, with as many as one in 10 patients waiting more than 200 days for a scan. That is why the province’s recent action to increase public MRI capacity to cut waiting times is welcome.

An accurate diagnosis is the first step to ensure a patient receives the right care. When stuck on a waiting list, a patient’s health can suffer, often leading to higher health costs.

The government’s MRI strategy includes running existing machines for longer hours, installing new machines and better organizing resources by centralizing patient intake regionally. This means 37,000 more MRIs will be done this year alone, with further increases next year.

For years, B.C. allowed public MRI capacity to fall far behind the national average, thus enabling a market for private MRI clinics to flourish.

Private clinics charge patients $650 to $1,000 a scan, compared with the $250 average cost of a scan in the public system with no charge to the patient. When faced with long waits in the public system, many patients have been forced to consider paying these steep fees for private scans.

What’s more, in a 2017 survey of private B.C. MRI clinics, the B.C. Health Coalition discovered all 14 we contacted appeared to be charging patients unlawful fees for medically necessary scans.

The previous provincial government allowed public capacity to fall behind while taking a “don’t ask, don’t tell” approach to unlawful private fees.

As a result, B.C. now has 14 private MRI clinics, the second-highest behind Quebec. Most provinces have zero to five such clinics.

This approach has increased inequities for patients in accessing health care: Private scans are unaffordable for many British Columbians and place a financial burden on others. And for patients with complex conditions, private MRI clinics may refuse to provide scans.

Privately obtained scans are also disruptive to the public system. Not only do they drain scarce health professionals such as MRI technologists and radiologists from the public system, they also distort one of the principle values many Canadians cherish about our public health system: that faster access to treatment should be given to those who need care most urgently, not those who can afford to pay privately.

Too often, when patients pay for a private scan, they are slotted ahead in the queue for surgery or other treatments in the public system because a scan is available, leaving other patients to wait even longer.

B.C.’s new strategy will mean shorter waits for public MRIs and a big boost to the public system’s capacity to meet the population’s needs, meaning fewer patients will have to consider paying for private scans.

Investment in increasing public diagnostic capacity will also support B.C.’s new strategy to reduce surgical waiting times. It involves making better use of existing operating rooms and pre- and post-surgical services by using evidence-based practices proven to reduce waits. Ensuring diagnostic services are at capacity and well-organized will be central to the plan’s success.

One task for the province will be to ensure the public system plays an important role in discouraging unnecessary diagnostic testing. This could be done by adopting guidelines such as the physician-endorsed “Choosing Wisely Canada” initiative.

In the meantime, the new MRI plan represents a direct departure from years of inadequate action on MRI waiting times and a “don’t ask, don’t tell” approach to unlawful private fees.

Best of all, it puts B.C. on track to ensuring all patients get the timely diagnostics they need in the public system.

Faster access to treatment should be given to those who need care most urgently, not those who can afford to pay