Eight years ago, Saskatchewan opened the door to patient-paid private MRIs. The biggest thing that happened was that not much happened.
Waiting times in the public system did not rise, contrary to the doomsday predictions of the most ardent opponents of any crack in the prohibition against allowing patients to pay for publicly insured services.
The numbers are clear enough. In fiscal 2015-16, the median wait time – with half of patients waiting less and half waiting more – peaked at 62 days in February, according to the province’s data. Private MRIs were just starting, with only 115 performed that year, less than 1 per cent of the provincial total.
But as the number of private MRIs ramped up, wait times in the public system did not rise. In fact, they edged downward after some initial fluctuations. By May, 2018, the median wait time was just 26 days, less than half of the February, 2016 level. By January, 2020, the median wait time had increased to 38 days, but was still lower than the 2016 peak. As of March, 2024, the median wait time had barely budged, edging up to 40 days, from 38 days in February.
Meanwhile, the number of patient-paid MRIs rose to 2,699 in fiscal 2024, or 6.5 per cent of the overall total. But the volume of publicly funded MRIs hit their highest level on record this January – a tidy refutation of the gloomy predictions of private health care critics.
So, how did Saskatchewan manage to ramp up private MRIs without cannibalizing the public system?
There are other factors, including separate decisions on funding for the public system, but a big part of the answer is smart design. The province requires that any private facility performing a patient-paid MRI must also provide a second MRI to the public system – free of charge. (That requirement shows up in the cost to private patients: one private company charges a starting fee of $990 in Saskatchewan but just $730 in Alberta.) In addition, patients must have a referral from a physician before they are able to go private.
Those rules have resulted in what should be celebrated as a success story. Wait times have been stable, even trending downward. (Indeed, if patients who paid for private MRIs were to be included, overall wait times would have undoubtedly decreased decisively.) And the public system has expanded the volume of MRIs performed, assisted by the private sector.
A separate set of data from the Canadian Institute for Health Information indicates that the trend for Saskatchewan’s MRI wait times compares favourably to other provinces (with the caveat that many factors are at play). Median MRI wait times in British Columbia, Manitoba, Ontario and Nova Scotia rose between 2019 and 2023, while those in Saskatchewan declined.
Ottawa, however, sees Saskatchewan’s success as a problem that needs to be punished and discouraged. The federal government reduced the province’s health care transfers by $742,447 last March to reflect the fees that patients paid to private MRI operators. In total, Ottawa clawed back $76-million from the provinces.
The Canadian Medical Association also takes issue with such private services. In its draft policy on public and private health care issued in late July, the association says that the use of any private services must be shown to reduce wait times. The document never quite states why that is.
What would be the logical objection if a parallel private option did not increase wait times in the public system but offered faster service for those who opted to pay? (That describes the situation in Saskatchewan.)
Other private-care skeptics spell out even tougher thresholds for such an option to be acceptable: no move of personnel from the public to private system, no matching increases in compensation for health care workers who remain in the public system and no inequitable effects. That latter condition, of course, automatically rules out patient-paid health care since some Canadians will not be able to afford the fee.
And that gets to the heart of the matter: The opponents of patient-paid care are against any reform that would speed up access for some Canadians, even if those in the public system are no worse off.
Saskatchewan has made patient-paid care work, through thoughtful design. That’s something the medical establishment and Ottawa should celebrate – not shun and punish.