1 THE PRIVATE PROVISION AND INSURANCE OF DIAGNOSTIC IMAGING SERVICES IN CANADA Nathaniel De Bono; Project Manager Renee Carter; MSc Dr. Amélie Quesnel-Vallée; PhD International Research Infrastructure on Social Inequalities in Health McGill University Department of Epidemiology, Biostatistics, and Occupational Health Department of Sociology
2 First privately funded MRI facility in Canada, 1993 Dr. Source: Brooks, J. (1993). Canada s first private MRI clinic: Does it signal a shift to two-tiered medicine? CMAJ
3 Within what policy framework do these clinics operate, and how prevalent are they?
4 Objectives 1. To determine how provincial regulations of the public and private funding of diagnostic MRI/CT services have changed over the past 20 years. 2. To characterize the extent that privately funded for-profit MRI/CT imaging facilities have been established during this time.
5 Why MRI/CT services? Between 1990 and 2005, the number of MRI and CT machines in Canada grew by 775% and 89%, respectively. 1.7 million MRI exams and 4.4 million CT exams were performed in Canada in ; this is more than double the number of exams performed in
6 Why MRI/CT services? Wait times for publicly funded scans a major concern MRI/CT scans an expensive innovation capable of being provided outside of hospitals Canada Health Act does not regulate the private funding of services outside of public insurance plans
7 Approach Policy indicators: 1. Do privately funded MRI/CT services exist? Utilized the Health Insurance Access Database (HIAD) Available at bitly.com/hiadaccess 2. What is the legality of private insurance for MRI/CT services? 3. Does private insurance exist for MRI/CT services? 4. Are there governmental regulations on out-ofpocket payments? Developed to measure the effect of increasing private health expenditures on health inequalities in OECD countries Extracted policy indicators specific to diagnostic care services for each province from
8 Results 1. Do privately funded MRI/CT services exist? 1. Do privately funded MRI/CT services exist? 2. What is the legality of private insurance for these services? YES Alberta (1993) British Columbia (1993) Quebec (1997) Nova Scotia (2002) NOT ANYMORE Manitoba ( ) Ontario ( ) 3. Does private insurance exist for these services? 4. Are there regulations on out-of-pocket payments? Saskatchewan New Brunswick NEVER Newfoundland & Labrador Prince Edward Island
9 Results 1. Do privately funded MRI/CT services exist? 1. Do privately funded MRI/CT services exist? 2. What is the legality of private insurance for these services? YES Alberta (1993) British Columbia (1993) Quebec (1997) Nova Scotia (2002) Ban extra-billing Ban user fees Ban direct-billing (QC, NS only) Require practitioners to opt-out 3. Does private insurance exist for these services? 4. Are there regulations on out-of-pocket payments? However These provinces have delisted medically necessary scans in non- approved free-standing facilities as publicly insured benefits. Practitioners can combine public and private income streams. Source: Flood and Thomas (2010) Blurring of the Public/Private Divide: The Canadian Chapter
10 Results Number of clinics selling MRI and/or CT scans for private payment by province, 2001 and 2012 NOTE: Ontario has a small number of clinics that accept private payment, but from third party insurers only Sources: CIHI, Selected Medical Imaging Equipment in Canada (2013); Health Canada, Canada Health Act Division (2005)
11 Results Location of MRI machines by type of facility in Canada, 2005 and % 85% 73% Source: CIHI, Selected Medical Imaging Equipment in Canada (2013) NOTE: All of the machines in free-standing facilities are used for privately funded scans except for a small number in Ontario
12 Results 1. Do privately funded MRI/CT services exist? 2. What is the legality of private insurance for these services? 2. What is the legality of private insurance for MRI/CT services? Alberta (1993) British Columbia (1993) Quebec (1997) Ban duplicative private insurance 3. Does private insurance exist for these services? Nova Scotia (2002) However No such ban 4. Are there regulations on out-of-pocket payments? Since MRI/CT services in free-standing facilities are delisted, prohibitions on duplicative private health insurance do not apply. Source: Flood and Thomas (2010) Blurring of the Public/Private Divide: The Canadian Chapter
13 Results 1. Do privately funded MRI/CT services exist? 2. What is the legality of private insurance for these services? 3. Does private insurance exist for MRI/CT services? Quebec: Products for sale in both individual and group markets Alberta, British Columbia, and Nova Scotia: Products potentially available in the group market; none found in individual market 3. Does private insurance exist for these services? 4. Are there regulations on out-of-pocket payments?
14 Results 1. Do privately funded MRI/CT services exist? 4. Are there regulatory limits on out-of-pocket payments for privately funded MRI/CT services? 2. What is the legality of private insurance for these services? 3. Does private insurance exist for these services? No regulations found Scans generally range in cost from $500 to $2000 depending on complexity and other bundled-in services. 4. Are there regulations on out-of-pocket payments? Medical Tourism Package at the Fairmont Hotel (QC) includes two night stay, CT/PET scan, transportation to clinic, breakfast and a massage.
15 Discussion What does this mean for people who need care? Thursday, August 23 rd 2012
16 Discussion Supportive role of private health insurance Duplicative: concerns for health equity Complexity of interactions between public and private health sectors Privatization: Potential for private health insurance to develop Recession in the 1990 s Wait times to access healthcare
17 Discussion Trade-off: equity versus efficiency De-listing: policy windows Rationing healthcare on the basis of willingness-topay Ability to pay versus need Horizontal equity: equal access for equal need Vertical equity: quicker access for greater need
18 Discussion Factors potentially contributing to health inequity HORIZONTAL EQUITY VERTICAL EQUITY Lack of price regulation for services offered in the private sector Jumping the queue: Implications for treatment and health outcomes Radiologists simultaneously practicing in public and private sectors Lower volume of patients treated in private sector
19 Key Points 1. Delisting with the intent to contain costs set the stage for privatization. 2. Private market growing and an increasing proportion of services are being delivered privately. 3. Potential threats to health equity due to an unregulated two-tiered system of care.
Womenand Private Health Insurance Why does Private Health Insurance Matter to Women? Women have a particular interest in the cost of health services. Women receive the majority of health care in Canada
CHEPA WORKING PAPER SERIES Paper 08-04 Private Health Insurance in Canada Jeremiah Hurley G. Emmanuel Guindon CHEPA WORKING PAPER SERIES The Centre for Health Economics and policy Analysis (CHEPA) Working
April 2015 DRUG COVERAGE for low-income families The Canadian reality and lessons from Switzerland and the Netherlands, by Nadeem Esmail and Bacchus Barua. Contents Foreword Dr. Brett Belchetz / i Executive
International Profiles of Health Care Systems Australia, Canada, Denmark, England, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States The Commonwealth
Product Stewardship in Canada Northwest Product Stewardship Council page i Product Stewardship in Canada LEGISLATIVE FRAMEWORK OF PROVINCIAL PROGRAMS Northwest Product Stewardship Council www.productstewardship.net
PROFILES OF SIX HEALTH CARE SYSTEMS: CANADA, AUSTRALIA, THE NETHERLANDS, NEW ZEALAND, THE UK, AND THE US TABLE OF CONTENTS INTRODUCTION FOR EACH COUNTRY: I. FINANCING AND COSTS II. HEALTH OUTCOMES III.
Working Paper 20 April 2014 WP 20 BUILDING BETTER HEALTH CARE Policy opportunities for Ontario Institute for Competitiveness & Prosperity The Institute for Competitiveness & Prosperity is an independent
Public / private mix in health care financing Dominique Polton Director of strategy, research and statistics National Health Insurance, France Couverture Public / private mix in health care financing 1.
Introduction In the deliberations of possible financing options to enhance the sustainability of Hong Kong s public healthcare system, reference has been made to the healthcare financing arrangements in
FUNDING FRAMEWORKS Understanding the methods used to finance post-secondary education in Canada Prepared by Navneet Khinda January 2014 1 TABLE OF CONTENTS I. EXECUTIVE SUMMARY...2 II. FORMULA FUNDING...3
The Effect of Wait Times on Mortality in Canada May 214 by Bacchus Barua, Nadeem Esmail, and Taylor Jackson Contents Summary / iii 1 Introduction / 1 2 A Review of the Literature / 4 3 Measuring the Relationship
Power prices in context: comparing Alberta delivered electricity prices to other Canadian provinces on a level playing field Prepared for the Manning Centre for Building Democracy and the Independent Power
HEALTH CARE HUMAN RESOURCE SECTOR COUNCIL A Study of Health Human Resources in Nova Scotia 2003 Human Resources Development Canada Développement des resources humaines Canada HEALTH CARE HUMAN RESOURCE
Too Good to Waste MAKING CONSERVATION A PRIORITY Contents 5 7 8 9 10 10 14 18 22 INTRODUCTION > Why Does Alberta Need a Waste Strategy Focused on Conservation? > Principles for Waste Management and Resource
2010 National Physician Survey : Family Physician Usage of Electronic Medical Records Inese Grava-Gubins, Artem Safarov, Jonas Eriksson College of Family Physicians of Canada CAHSPR, Montreal, May 2012
The Use of Student Level Data to Provide Information on Student Pathways and Mobility: A Study of the Statistical Journey Through Canadian Lifelong Learning The Council of Ministers of Education, Canada
CSSA Annual Steward Meeting Q&A, October 31, 2013 Question Canadian Stewardship Services Alliance 1. Under the new structure who will issue stewards invoices and who will stewards pay their invoices to
www.ccsa.ca www.cclt.ca National Treatment Indicators Report 2011 2012 Data January 31, 2014 National Treatment Indicators Report 2011 2012 Data January 31, 2014 This document was published by the Canadian
POLICY BRIEF Private Health Insurance in OECD Countries September 04 What is the role of private health insurance in OECD countries? Does private health insurance improve access to care and cover? Does
FACT SHEET The Competition Commission s Market Inquiry into the Private Health Care Sector 1 www.section27.org.za @Section27News SECTION27news Tel: +27 11 356 4100 l Fax: +27 11 339 4311 5th floor Braamfontein
Public Private Debate Whether the health care delivery system should be public or private or a mix in terms of funding and delivery was a hotly debated topic throughout the Conversation on Health. There
Chapter 3 Section 3.01 Financial Services Commission of Ontario Auto Insurance Regulatory Oversight Chapter 3 VFM Section 3.01 Background The Financial Services Commission of Ontario (FSCO) is an arm s-length
Ministry of Education Plan for 2014-15 saskatchewan.ca Statement from the Minister I am pleased to present my Ministry s Plan for 2014-15. The Government s Direction and Budget for 2014-15 are built on
Lessons from Abroad A Series on Health Care Reform Health Care Lessons from Australia by Nadeem Esmail Foreword by Janice MacKinnon, former Saskatchewan NDP Finance Minister Contents Foreword by Janice
Our Vision Better data. Better decisions. Healthier Canadians. Our Mandate To lead the development and maintenance of comprehensive and integrated health information that enables sound policy and effective
Document 213108 Table of Contents Page Background 3 Executive Summary 4 Introduction 11 Health Care Funding Models 12 Health Care Costs 15 Use of Health Care Funds 18 Health Care Resources 19 Health Care
The End of Need Based Student Financial Aid in Canada? Prepared for: Canadian Association of Student Financial Aid Administrators (CASFAA) By Sean Junor and Alex Usher August 2007 About CASFAA The Canadian
A report to the Health Council of Canada Canadian Perceptions of the Health Care System Stuart N. Soroka McGill University February 27 Health Council of Canada Suite 9, 9 Eglinton Avenue East, Toronto,
How Does Private Finance Affect Public Health Care Systems? Marshalling the Evidence from OECD Nations Carolyn Hughes Tuohy, PhD, Colleen M. Flood, SJD, and Mark Stabile, PhD University of Toronto 1 INTRODUCTION