Government & Medicine

"Where MRI?" wonders Health Minister

Pierre Pettigrew opens up a P3 can of worms
� and just as quickly tries to put the lid back on

By Giancarlo La Giorgia

The debate about private investment in public healthcare just got a whole lot hotter, thanks to federal Health Minister Pierre Pettigrew's recent media gaffe. Pettigrew recently announced his plans to open a dialogue with those provinces currently allowing private, for-profit magnetic resonance imaging (MRI). The next day, presumably after a dressing down from his boss, he was back-pedalling furiously, telling reporters that "the ambition of the federal government is not to encourage private delivery, even within the terms of the Canada Health Act."

Mr Pettigrew is just the latest in a long line of federal health ministers to have to 'clarify' Canada's position on these controversial, illegal, clinics, since they first appeared on the scene in 1993. In 2000, then-Health Minister Allan Rock threatened to cut off transfer payments or fine provinces that allowed private imaging clinics to charge patients for medically necessary procedures. But nothing came of it. Last year, Mr Pettigrew's predecessor, Anne McLellan, demanded in a private letter to the provincial Health Minister that Quebec shut down its for-profit imaging facilities or face the consequences. But so far, not one for-profit MRI clinic has ever been shut down.

RADIOLOGISTS SPEAK OUT
Dr Normand Laberge, CEO of the Canadian Association of Radiologists (CAR), is a strong opponent of privatization and is appalled that political inertia has transformed certain medical domains � radiology, pathology and lab testing � into for-profit businesses.

"This is only the tip of the iceberg for the medical profession," he cautions, adding that, as more businesspeople with no medical background enter private health- care, physicians risk losing their professional integrity.

Dr Laberge argues that the government could avoid public-private partnership (P3) quick-fixes and increase public access to MRIs by training more diagnostic radiology and nuclear medicine physicians, thereby minimizing the amount of unnecessary "yuppie scans," revamping waiting list criteria and running MRIs at full capacity. Instead, he says, politicians pledge more machines while letting the private sector expand because most healthcare costs are in providing services.

PRIVACY CHAMPIONS
However, for P3 pioneers like Dr Sheldon Elman, the belief that the public system can meet all the health needs of our aging population is "pure fantasy." "Hospitals have outsourced their kitchens, laundry and information technology to the private sector and it's working," he says. "The hospitals are saving money and the private enterprises are making money. Why on Earth can't some of these basic principles be applied, with proper regulation, to healthcare services?"

Dr Elman is the president and founder of Medisys, Canada's largest provider of private health services, including MRIs. Incidentally, he's also the long-time FP of our "no chequebook medicine" Prime Minister, Paul Martin.

THE REAL PROBLEM
The need for diagnostic imaging is growing at a rate of 6% per year, but Dr Elman says most healthcare spending in recent years has gone towards improving infrastructure or paying staff. Even with $1 billion earmarked for diagnostic imaging machines under Jean Chr�tien, there still aren't enough radiologists to run Medicare-funded MRI scanners for more than a few hours a day.

Widespread dissatisfaction with wait times, especially for diagnostic imaging, has helped make healthcare the number one pre-election issue among 80% of voters. Nevertheless, Dr Laberge says both private clinics and the government benefit from long queues in the public system. "If people could get timely access, private clinics would be out of business," he says, "but the regulating valve [for healthcare costs] is the waiting list. If you get rid of waiting lists, there's no end to spending."

HEALTHCARE IN RESERVE?
In Saskatchewan, where for-profit imaging clinics are prohibited and waiting lists are longest, the backlog for an MRI is about 22 months. Faced with that, many travel to Alberta and pay between $500 and $800 at a private clinic. Provincial Health Minister John Nilson has responded to growing public anger by promising money for another MRI scanner. However, he opposes an aboriginal community's plan to build an MRI clinic on their reserve later this year.

Lester Lafond, the Muskeg Lake Cree businessman behind the project, says his community originally wanted a Medicare-billable clinic, but will go for-profit instead if Mr Nilson doesn't budge. Mr Lafond also says that several other aboriginal communities are planning to enter the private healthcare market. "Any time you can move the waiting list from 22 months even to 15 is an improvement. Maybe we can move it from 15 down to six if another First Nation group opens a clinic," he says.

While Dr Normand Laberge disagrees with these particular methods, he agrees with the results. "As a physician and the head of CAR, I don't favour privatization, but you can't tell someone to wait a while and risk dying," he says.