Tuesday 14 November 2000
Your back is killing you, your doctor suspects you have a herniated disc and so he sends you for an MRI.
In a hospital, the wait for magnetic resonance imaging - essentially, a painless way to "see" through bone - is four months. In a private clinic, it is a matter of a day or two and your private insurance covers it.
Where would you choose to get it done?
"Our patients are leaving for the clinics because they're fed up waiting," said Dr. Adel Assaf, a radiologist at the Montreal General Hospital who is trying to start up a private MRI clinic in downtown Montreal.
"There is a need for this, and that's why we're trying to increase the services. It's not very nice when you have to wait months on end for an MRI."
But that's not how Ottawa sees it.
Yesterday, echoing earlier warnings by federal Health Minister Alan Rock, Prime Minister Jean Chretien threatened to penalize Quebec and other provinces that allow private clinics to do magnetic resonance imaging.
The Canada Health Act forbids user fees for services already covered by medicare, and a single MRI scan can cost a patient $500 or $600 outside a hospital.
Quebec, Ontario, Alberta and other provinces have allowed private clinics to do X-rays, CT scans, ultrasounds and the newer MRI scans for years, seeing them as a way of easing waiting lists in hospitals.
But Chretien wants the provinces to discourage this type of "two-tier medicine" - one level for the "rich" who have insurance, another for the "poor" who have only medicare - by spending more on public hospitals.
To do that, Ottawa agreed last month to give the provinces millions of dollars specifically for medical diagnostics.
Yesterday, Chretien warned that funding will be cut off unless the private MRI clinics are closed.
"If they keep them, we will withhold the money," the prime minister said.
Doctors like Assaf think that would be a shame.
He heads a group of 20 disgruntled radiologists who plan to open a private clinic in March to cope with a backlog of waits for MRI, a radiation-free technique of medical diagnostics.
If it goes ahead, the Ste. Catherine St. W. clinic would be one of several across the region - in Montreal, Town of Mount Royal, Laval, Longueuil and other cities - that offer MRI services to a paying clientele.
"It's not really a question of two-tier medicine," said Dr. Sheldon Elman, founder of the Montreal corporate medicine company Medisys Health Group. When its clients - sports figures, for example - need a quick MRI, Medisys sends them to its affiliated clinic, the MRI Scan Centre, on Cote des Neiges Rd. It has been in operation since 1998.
Last fall, National Hockey League defenceman Vladimir Malakhov (then with the Canadiens) was rushed there for an MRI after injuring his knee in an on-ice collision. Subsequent surgery in the United States left him sidelined for months.
"Everything we do is all in conjunction with the Canada Health Act - it's not a problem in that regard," Elman said yesterday from San Francisco.
Aren't the provinces violating the Health Act by allowing parallel services like his? Elman wouldn't elaborate. "While the election is going on, I really feel I don't want to say anything more about this."
Assaf was less hesitant.
Ottawa is dreaming if it thinks the private clinics will just go away, he said.
"There are hundreds of clinics all over Canada and if they're going to start dismantling them, they're in for a long job," he said.
Medical diagnostics won't get better overnight just because hospitals are richer, he added. "The money is not there yet and before anything new is opened, it takes ages to get going - that's a fact."
In Quebec these days, waits for MRI scans are four to nine months for the knee (torn ligaments, meniscus injuries), two months for the brain (lesions, multiple sclerosis) and four months for the spine (herniated discs).
Private-insurance plans cover 80 to 100 per cent of the cost the procedure, typically $500 a scan, Assaf noted. "It's cheaper than in the States - there, it's more like $2,000."
MRI machines themselves cost between $500,000 and $1.5 million to buy. They contain a very large magnet, a radio-wave transmitter and a computer that together construct detailed pictures of parts of the body.
Because they can "see" through bone, MRIs are especially useful for
viewing the brain and spinal cord. They are also often used to examine
injured joints, such as knees and ankles.