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.