Queue jumping has become a nasty phrase to Albertans who have endured years of queue-jumping accusations involving the Calgary Flames and politicians.
A formal inquiry that was supposed to reveal the grand scale of this ubiquitous phenomenon has now ended and the results are in — queue jumping has occurred, but isn’t a common practice.
Unfortunately, this outcome has not deterred others from utilizing the term in a Chicken Little-like effort to change the health-care system.
The College of Physicians and Surgeons of Alberta, the regulatory body for the province’s doctors, says Albertans who pay to have MRI scans performed at private clinics are jumping the health-care queue, and it’s not fair.
Apparently, the notion of paying for medical services offends the college and its mandate to uphold the Canada Health Act. The college believes that access to health care should be based on medical need only, and not on the ability to pay.
Consequently, the college is proposing revisions to its Standards of Practice Guidelines that would forbid physicians from charging fees for uninsured services and force physicians (and private MRI clinics) to stay under the umbrella of the public health-care system.
The college admits that it is beyond the scope of its mandate to ban private MRI clinics, but says it may call on the provincial government to do the deed in an effort to stop the queue jumpers. College registrar Dr. Trevor Theman made this clear, saying, “We don’t think you should be able to buy an MRI or CT scan privately.”
Theman also claims the college is doing all this for you. He says the college is an “advocacy group for the public,” not the profession.
Then perhaps he should pay attention to an informal online Calgary Herald poll, where just 18 per cent of 3,596 respondents agreed with his proposal and an overwhelming 82 per cent voted against it.
Perhaps he should also listen to his own constituency, the medical profession. The Alberta Medical Association says private clinics are part of the solution to limited resources in the public system and not the problem.
The real problem in obtaining an MRI scan isn’t queue jumping. It’s that waiting lists have become intolerably long.
Waits at the 11 or so private imaging clinics are minimal and appointments are typically arranged within a couple of days. The cost is about $750, and for those who need a diagnosis and treatment quickly, it’s a legitimate option.
According to the Fraser Institute’s 2013 Provincial Healthcare Index, Albertans wait an average of 11.5 weeks for an MRI scan. Those deemed emergencies can be done within a week or two, but those who have non-urgent problems can wait as long as 37 weeks — that’s over nine months — until a diagnosis can be made. Access to treatment requires even more waiting.
Even those with a proficiency in remedial math can easily see what the college apparently cannot: Eliminating the private MRI clinics will only extend the wait times at public facilities and increase the costs to a health-care system that is already overwhelmed by costs and limited in its resources.
So is the college really advocating for you and your health care?
Theman claims the college is responsible for upholding two key principles of the Canada Health Act — universality and accessibility.
First, the Canada Health Act doesn’t mention access as a key tenet — it mentions “reasonable access.” Three days’ wait for a MRI scan is reasonable; nine months is not reasonable, nor clinically acceptable.
Second, universality and reasonable accessibility are increasingly becoming mutually exclusive concepts. In a system with finite resources, opening the flood gates of universality will certainly slam the door shut on the timely accessibility to procedures.
Paying homage to universality in a broken and bankrupt system, as suggested by the college, is radical, idealistic and impractical. It creates more bureaucracy, prolongs waiting lists and makes it more difficult for patients to access the health care they need.
Patients don’t care about private access to the system, they care about access. If some Canadians can afford to pay for care, it eliminates some burden on the public system and shortens the waiting list for public care. That makes common sense.
The real problem with MRI scans isn’t private clinics and queue jumping, it’s the waiting list. That is what patients want doctors and governments to fix.
A key problem — and one that can be fixed — is the inappropriate use of MRI imaging. A March 2013 study in JAMA Internal Medicine found that more than one-half of Alberta’s MRI scans for lower back pain were either inappropriate or provided an uncertain value for the patient.
Another factor is utilization of MRI scanners. Ontario has 99 MRI units and they perform an average of 7,358 scans each. In contrast, Alberta has 36 scanners and an average of 5,630 scans per scanner. Why the difference?
It’s time to forget about the idealistic and unreasonable egalitarian notions presented by the Canada Health Act and take action that gives patients access to the health care they need — and when they need it.
Susan Martinuk’s column appears weekly. She is a medical research consultant and recently authored a peer-reviewed report, The Use of Positron Emission Tomography (PET) Technology in Cancer Care Across Canada: Time for a National Strategy.
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