Nov 10
8
MRI services blur lines on for-profit health care
National Post – November 5, 2010
MRI services blur lines on for-profit health care
By Tom Blackwell
Major Canadian hospitals are hosting for-profit services that sell speedy MRIs and CT scans to fee-paying patients, part of a surprising, parallel private health system that appears to stretch countrywide. The businesses – at Mount Sinai and St. Michael’s hospitals in Toronto and many others like them – say they are not violating laws that bar Canadians from buying medically necessary treatment, but taking advantage of a little-known quirk in medicare rules that allows “third parties” to seek care outside the public system. The concept has long applied to workers’ compensation clients, RCMP officers, military personnel and even prison inmates – all of whom are effectively excluded from provincial health plans – but recent interviews reveal that the third-party exemption now stretches much further. Private auto and health insurers, law firms, sports clubs and individual employers and corporations are also being allowed to purchase expedited care for patients who normally would be prohibited from doing so.
An Alberta-based insurance company is selling policies to employers and individuals in the West, Ontario and Atlantic Canada that will provide patients expedited MRIs and CT scans and even speedy visits to a range of specialists if they face lengthy wait times in the public system. Acure Health’s service is possible because the bill is paid for by an insurer – a third party – but Jim Viccars, Acure’s president, said his company is not stealing from the public system, only tapping into unused capacity. “The reality is that the system right now is faltering under incredible burdens of demand, versus the ability to meet that with provincial revenue,” he said. “This kind of program can alleviate a lot of that…. No one needs to wait in pain.”
One Toronto man said he turned over $850 recently to get the MRI scan his doctor had recommended within two days, versus waits of up to two months for a taxpayer-funded scan on the same machine. Staff at the Mount Sinai third-party service told Greg Martin he just had to make sure it was paid for by a corporation, which happened to be his own computer-consulting business. “The clinic questioned me… to make sure I had pre-printed company cheques and to make sure it was a legitimate company,” said Mr. Martin, who would like to see more private medicine. “We obviously need to support the public system, but if people can afford to pay for it, then let them.”
Some of the third-party diagnostic imaging services are offered by private companies that use publicly owned equipment within hospitals part-time, some by the hospitals themselves and at least one in Ontario is a privately owned MRI suite within a public hospital, St. Michael’s.
At Mississauga’s Trillium Health Centre, a representative for the hospital’s service told an anonymous caller a patient can get an MRI or CT scan in three days or faster, and have it paid for by a corporation. “Even if it’s your own company and your own money in a sense, if it’s the company that’s making the decision for your wife, that’s the way we need to do it, so it looks like it’s a legitimate sort of expense for the company,” the employee said.
It all adds another twist to the continuing debate about Canada’s single-tier system and the seemingly expanded role being played by private medicine. The phenomenon is particularly striking in Ontario, where the Liberal government actually converted several private imaging clinics to non-profit facilities in 2004, saying “MRI services will be driven by community need, not by profit.” David Jensen, a spokesman for the Ontario Health Ministry, said yesterday the province funds hospitals and clinics to provide a certain number of hours of medicare scanning service. Outside those hours, they are free to use the machines to provide “uninsured” services, those that do not fall under the provincial health plan.
It would seem, though, that third-party customers are often funding care that would normally be covered by medicare. And some critics argue that is a potential threat to the integrity of universal health care. “It’s relentless: Medical entrepreneurs trying to exploit the system for money … it easily escalates out of control, so you lose single-payer, universal access,” said Michael McBane, spokesman for the union-backed Canadian Healthcare Coalition. “It’s the thin edge of the wedge … If they don’t get beaten back, they will grow like a cancer.”
One diagnostic-imaging entrepreneur catering to third parties, however, said the exemption makes perfect sense, allowing employers to get sick or injured staff back in the saddle sooner. “I don’t think it’s a loophole: This is well considered,” said Bruce Bronfman of Ontario MRI Centres, which operates the services at Mount Sinai and at Toronto’s Humber River Regional Hospital. “It’s important for the Ontario economy.”
For Trillium, the third-party service uses machines when they would otherwise be idle, while providing crucial funding for public care, more work for radiologists and added job security for technologists, said Larry Roberts, a spokesman for the Ontario hospital. Private companies and others catering to third parties say the bulk of their business comes from workers’ compensation, car-accident victims funded by insurers and federal police or the military. At Halifax’s Healthview Medical Imaging, which owns its own private MRI clinic, about 20% of patients have their scan paid for by others, such as workplace health plans, or actually pay out of their own pockets. For $800, patients get a scan within three to five business days, compared to waits of up to six months in Nova Scotia’s public system, said Dr. Derrick McPhee, a radiologist who works full-time on the public side and after hours for Healthview. Dr. McPhee argues the company actually helps medicare by taking thousands of patients off waiting lists annually.