Imaging tests : the good reflex of the minister Barrette

Photo Stevens LeBlanc

Patrick Déry

Thursday, 8 February 2018 16:16

UPDATE
Thursday, 8 February 2018 16:31

Look at this article

You wait for months to pass an exam, magnetic resonance imaging (MRI) or computed tomography (CT or CT scan, in good French)? Your expectation has no reason to be.

A survey carried out by The Press comes from the effect of revealing that the medical imaging equipment of our hospitals are greatly under-used. The situation is worse in big cities… where the wait times are the longest!

In principle, these devices should be used 16 hours per day. In practice, it can come down to as little as eight or ten hours in a week. The end of the week, it is still less. Sometimes, we let in a standby mode until Monday.

Thus, the all-new CHUM, six MRI scanners work only eight hours per day, so that there are 7000 patients on the waiting list (one of which has been waiting since November 2015…). The end of the week, only one of these devices works. The six CT scanners are also under-used : they work ten hours a day in the week. The end of the week, two-thirds of the devices take the dust.

The portrait varies a bit depending on the types of devices, but we find similar situations at the MUHC, the university hospital of Sherbrooke, Cité-de-la-Santé de Laval, and Pierre-Boucher in Longueuil, among others.

We also learn that a patient of Laval has been waiting for a year and a half to review a CT of the brain. I hope he doesn’t have too much of a headache…

The news is doubly troublesome since, in December last, the minister of Health, Gaétan Barrette, had publicly stated that the medical imaging devices were operating 16 hours per day ” wherever there was the expectation and availability of staff “. Obviously, it was ill-informed.

The minister is also said to have “invested” (read : spent) $ 7.2 million for nearly 100,000 imaging examinations additional, and given instructions “to the network” to reduce the waiting lists. Why, then, tens of thousands of patients are waiting-they always? Why the ” network “, this monster two-hundred heads, not listening to a-t-it be no longer the minister?

Because there is a lack of staff in the hospitals to carry out the examinations, according to a head of department at the CHUM quoted in the article. And why is not commited there not more staff? Because for a hospital, a patient is an expense. As revenues are essentially fixed, the managers of hospitals limit the expenditure, so the number of patients, and the costs that come along with it. The result is imaging devices that are under-used while patients are waiting.

This logic of rationing of care that prevails among us is reflected in, among others, the wait at the emergency, access to specialists and time to get a surgery that is not urgent, three areas where the performance of Quebec is particularly shameful in light of that of other developed countries.

A beginning of solution

To overcome the problem, the minister is considering to ensure that the examinations of MRI and CT made in private practice are covered by medicare (as is the case for x-rays. Have you noticed how it is usually quick and effective?). It is a part of the answer. The organization of private clinics is definitely more flexible and more responsive than the bureaucracy of hospital. But the minister could also give a helping hand to the hospitals.

In fact, if the clinics are more likely to react to the requests of patients, it is because they represent for them an income. Therefore, they want more, not less! The same principle should apply to hospitals. The department is in the process of revising their funding formula, but it takes time.

More generally, the use of private providers within the public system is welcome. Most European countries have recourse to, and their health systems are generally more efficient than ours. Employees (physicians, nurses and other health workers) can also benefit from the fact of working for an organization with flexible, decentralised and which promotes the ideas coming from the database.

The minister Barrette has the good reflex of wanting to diversify the suppliers of imaging, they should be encouraged to go forward. It is not a matter of draining the resources of hospitals, on the contrary : they must have the right incentives in terms of funding in order to meet the needs of patients, such as activity-based funding. But add flexibility and increase the supply to the inside of the public system using private providers is also part of the answer.

And all this can be done by preserving the universal access, as it is done in most developed countries.

To reach me : patrick.dery@iedm.org

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