The Saskatchewan government’s controversial for-profit MRI plan has now drawn the ire of the federal government. Federal health minister Jane Philpott has written to Provincial Health Minister Jim Reiter, telling him she would like Saskatchewan to “put an end” to encouraging private payment for medical scans.
“While the ‘two for one’ model you have enacted is unique,” Philpott wrote in her letter to Reiter, “it still allows wealthier patients to jump the queue, both for initial diagnostic services, and for any follow-up care that may be required within the public system.”
Because the private MRI legislation is contrary to the fundamental principle of the Canada Health Act, she asked Reiter to “put an end to the current practice of encouraging private payment for diagnostic services and focus instead on ensuring that all residents have access to medically necessary services in a timely manner, regardless of ability, or willingness, to pay.”
Philpott warned Reiter that provinces that allow charges for medically necessary services “are subject to mandatory dollar-for-dollar deductions to the Canada Health Transfer payments.” Earlier this year, Philpott gave a similar warning to Quebec for allowing doctors to charge user fees and the Quebec government announced it would disallow the practice.[i]
Reiter’s letter in response was defiant. He insisted that their “innovative” two for one legislation meant over 1,100 patients on the public wait list received a free MRI scan, saving the public health system nearly $1 million. He wrote that the government will continue to allow private pay MRIs and that they “fully intend to proclaim” the legislation that expands the scheme to CT scans.
The implications of the Wall government’s dismissal of Philpott’s warning means that Saskatchewan, with a $1 billion deficit, could have its federal health transfer payments reduced for every dollar that has been privately paid for medically necessary MRI (and CT) scans. How much that will be, we don’t know, but it would be the total amount paid by individuals to the private clinics since the MRI law came into effect.
Who’s paying for private MRIs anyway?
It is quite astounding to think that there were 1,102 people in the Regina Qu’Appelle Health Region who were willing to pay out of pocket for a private MRI, as Reiter claims. Who has that kind of money? Why are they so desperate?
As it turns out, there really weren’t that many.
Although the government reported that 1,102 people privately paid for MRIs, in fact the majority of the bills were paid for by two organizations, the Workers’ Compensation Board and the Saskatchewan Roughriders. Assistant deputy health minister (ADM) Mark Wyatt admitted in committee that of that number only 384 individuals paid privately for an MRI.[ii]
That the government would include the third-party payments in its overall stats is dishonest. The WCB and our green and white club have been paying for private MRIs and offering up a free MRI to the public wait list for many years, long before the government introduced its MRI Facilities Licensing Act.
The government should be reporting only 384 privately paid MRI scans, resulting in a reduction of 768 from the public wait list after the second scan – not the 2,200 claimed by Minister Reiter.
Interestingly, the government’s own wait list website shows that the wait times for MRIs increased after the introduction of private-pay MRIs(from 150 days to over 200 days).
The new public MRI scanner at the hospital in Moose Jaw, which began operations early January, has performed more MRI scans for those on the public wait list (983 patients) in its first eight months of operation than have the private MRI clinics (WCB and Rider patients are not on the public list). This confirms the view that the best way to reduce wait times is by improving public capacity.
Shifting costs onto individuals
Health ADM Wyatt, confirmed that the ministry is not tracking what the private facilities are charging for scans and that prices are not regulated. [iii] The private MRI clinics in Regina are free to charge whatever they please.
Let’s be clear: the private MRI clinics are not providing a second scan to someone on the public wait list for “free”; nor are they losing any money. Without a doubt, they are charging enough to cover the cost to perform two scans plus a healthy profit.
The Wall government’s private clinic “innovation” is not at all innovative. It’s about making people pay for services already covered by tax dollars. This is not saving money as much as it is shifting higher costs onto individuals who are legally entitled to free medically necessary health care.
And yet, despite the dubious value of the government’s private MRI plan and the warning from the federal government that its private user-pay MRI legislation violates the Canada Health Act, the Saskatchewan government appears ready to go one step further in its privatization of health care.
Privatizing through the “back-door.”
The dubiously titled Patient Choice Medical Imaging Act (Bill 26) was passed by the Saskatchewan legislature at the end of November 2016. The bill repeals the MRI Facilities Licensing Act, which came into effect February 29, 2016, and extends its private pay MRI scheme to include CT scans. This was one of the Sask Party’s election promises in the spring 2016 election campaign.
But it appears that the legislation opens the door to any other kind of medical imaging services that the government wants through a simple change in regulation.
Bill 26 defines medical imaging services as: (a) magnetic resonance imaging services; (b) computerized tomography services; or (c) any other prescribed medical imaging services. By including “any other prescribed medical imaging services,” the government will be able to simply change regulations without legislative debate to add any other medical imaging service it wants – from ultrasounds to x-rays or mammography services.
While the government insists it is adding only CT scans to the roster of private user-pay services, opposition health critic Danielle Chartier repeatedly pressed the health minister in committee to explain the reasons behind the open-ended category in the legislation.
“There’s no plans to do that right now, but we’re certainly not ruling out considering something like that at some point down the road,” replied minister Jim Reiter.
He later added, “Again, there’s no plans for anything at this point. So it would be hypothetical for me to start surmising.”
To which Chartier responded, “When you put something in the bill it may be hypothetical, but it’s in the bill for a reason. Otherwise we should just take it out of the bill.”[iv]
For a government that claims to have no immediate plans to privatize other imaging services, it seems very protective of its open-ended clause.
When Chartier attempted to amend Bill 26 in committee to remove the open-ended “any other service prescribed” clause, it was voted down by the government majority on the committee. It seems the government is very reluctant to shut the door on even further future health care privatization in Saskatchewan.
Cheryl Stadnichuk is a researcher with the Canadian Union of Public Employees (CUPE) in Saskatchewan.
[ii] ibid., page 310.
[iii] ibid., page 311.
[iv] Standing Committee on Human Services, Hansard Verbatim Report, Legislative Assembly of Saskatchewan, No. 18, November 21, 2016, p.323.