Sask. MRI model putting federal dollars at risk, NDP says

Saskatchewan's Opposition NDP says the provincial government's model for access to MRI scans is putting federal health care dollars at risk.

In 2016, the province introduced a one-for-one MRI system, allowing patients to pay for their MRI at a private clinic. In return, the private clinic has to provide an MRI scan to someone on the public wait-list within 14 days.

After the one-for-one initiative was introduced in 2016, Jane Philpott — then the federal health minister — wrote to her counterpart in Saskatchewan, telling him she wanted the province to "put an end" to encouraging private payment for medical scans. That has not happened.

The two sides are now coming up on a deadline that could mean a clawback of health money from Ottawa.

"It's putting us at risk of actually losing dollars — losing federal health dollars that we need for our emergency rooms for long-term care," said NDP Leader Ryan Meili.

As of April 1, 2020, the federal government's Diagnostic Services Policy will kick in. Announced in 2018, Ottawa gave the provinces warning that it would make deductions from Canada Health Transfer payments if they had user-pay models.

The federal policy said it is "aimed at eliminating patient charges for medically necessary diagnostic services (such as MRI and CT scans)."

It clarifies that "the Canada Health Act will be enforced and that evidence of patient charges will result in a mandatory dollar-for-dollar deduction from Canada Health Transfer payments."

Reporting would start being tracked in 2020-21 and any deductions taken would start in March 2023.

Meili said the province's MRI model should be scrapped entirely.

"It doesn't work for people to get health care. It doesn't shorten wait times and it's now putting us at risk of losing these dollars because it's actually against the Canada Health Act," he said.

"It was never a good idea to begin with."

Health minister hopeful

Saskatchewan Health Minister Jim Reiter sent a letter to his current federal counterpart, Patty Hajdu, in February, asking to discuss Saskatchewan's model and what he described as its "positive impact on our province."

Reiter said Tuesday he was still waiting on a response from Hajdu, but would prefer an in-person meeting.

The federal health minister's office provided a statement to CBC, saying "the new rules announced in 2018 will apply come April 1, and we will continue to work with the Government of Saskatchewan to make sure our health system remains one based on need, not ability to pay."

Reiter said the only difference between Saskatchewan's policy and policies in other provinces with private MRIs is the one-for-one model.

Forcing Saskatchewan to do what other provinces are doing, Reiter said, "would be a step backward, so I'm hopeful that if I can make that case that common sense will prevail."

As for how much money is at stake, Saskatchewan's Ministry of Health said it does not have an indication of the "financial penalties" from Ottawa. 

Reiter said if the current system was not in place, 4,600 people would be on a waiting list for an MRI scan.

He said he is "concerned" by the increase of the wait-list and wait times.

"In the last three years we've increased capacity by about 11 per cent but the referrals have increased by about 18 per cent."

Reiter said part of the reason for the increase in demand is that MRI scans are the "go-to tests" for doctors.

Wait times, waiting lists increasing 

The waiting list for an MRI in Saskatchewan doubled from 2015 to 2019, despite the government initiative allowing patients to pay for a scan and extended MRI hours at hospitals.

According to the provincial government's most recent figures, there were 10,018 people on the wait-list as of June 2019, up from 5,005 in April 2015.

The number of requests for MRIs rose steadily over the four years as well. In June 2019 there were 3,668 requests for MRIs and 2,940 visits. 

Wait times are also on the rise. In 2015, the average wait for an MRI was 55 days. In 2019, the average was up to 70 days.

The median wait time — the measure of how long it takes half of patients to receive their test — has also increased.

"The time it takes to clear half of the people off the list going up. That means things are slowing down somewhere in the system," said Tom McIntosh, the co-director of the Saskatchewan Population Health and Evaluation Research Unit, which is run jointly by the province's two universities. 

"Wait-lists and waiting time need to be actively managed. There are no silver bullets. You can't say, 'Well, we'll do this and  fix it.'"

Auditor to examine MRI system

Last month, Saskatchewan's provincial auditor, Judy Ferguson, said an upcoming report will look at whether the Saskatchewan Health Authority is properly tracking how the MRI system is working.

The health authority should focus in 2020 on tracking information and the root causes of wait times, Ferguson said. 

That could include making sure physicians are using the MRI appropriately and not sending people for scans when they should not be, understanding intake to receive an MRI, making sure a request is received by the radiologist in a timely fashion, understanding patient outreach and communication, and tracking the reasons for each rescheduled appointment. 

"Those are things that are important," Ferguson said. "There's some things that do seem like they're working, but if you're waiting for an MRI, you're still waiting."