Skip the doctor, pay for the scan, break the system

This week, the Alberta government will start allowing members of the public to decide whether they need a medical diagnostic test (like a CT or MRI) and pay privately to receive it—without referral from a doctor. It’s a bad idea that’s going to cost the system more money and lead to unneeded harm for many patients.To be clear, I would predict it’s not just total costs that will rise but also costs in the public system.All doctors know, a whole-body MRI often picks up “incedentalomas”—findings that would likely never have resulted in any health issues but once found you can’t ignore. This means follow up tests. Usually not just one but often several over years. And sometimes tests that are invasive, like a biopsy, that can carry risk. What happens when someone has any kind of finding including a minor one in this new Alberta paradigm? Likely they will visit their overstretched family doctor in the public system to understand what to do. And where will the follow up tests be? Likely in the public system.Our health systems (like all health systems in the world) are under strain and diverting some of our resources to “low value” care (e.g. MRIs that are not needed) or private-pay care means fewer resources for medically necessary care and the public system. For example, if a radiologist is interpreting tests in the private pay system, they are not spending that time in the public pay system. As a result, wait times in the public system grow. This is particularly true in a context like ours where we have relatively few doctors per population compared to other countries. The result? Some people get fast access (to tests they don’t need), while others languish on a wait list for tests they do need. It’s a result counter to the values of people in Canada who believe medical care should be based on need not ability to pay.Physicians have worked hard over the years to practice evidence-based testing—only ordering expensive tests like MRIs or CT scans when medically-necessary, where research evidence tells us that the test can improve care for patients and where the benefits of testing outweigh the harms. High-performing, cost-effective healthcare systems all have provisions for this type of “gatekeeping” by a trained professional. In systems where there is no gatekeeping, there is usually an excess of resources, including professionals—something we don’t have. And costs are higher because inevitably there are unnecessary tests and visits.Yes, long waits for diagnostic tests are a problem in Canada. This is not the way to fix it.Dr. Tara Kiran is a family physician at St. Michael’s Hospital, Unity Health Toronto, the Fidani Chair of Improvement and Innovation at the University of Toronto, and host of the podcast Primary Focus. This item originally appeared on LinkedIn.

Skip the doctor, pay for the scan, break the system

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