"Natives plan private MRI clinic"

[Guest Ian Wong]

Here's an interesting story that appeared in today's National Post. The Muskeg Lake Cree Nation band is planning on building facilities to house a private MRI machine. The Canada Health Act forbids physicians from charging for medically-necessary procedures (although they can charge for procedures that are not medically-necessary). That's why you can pay out of pocket for a facelift from a plastic surgeon, but couldn't pay out of pocket for an immediate knee replacement, or cancer surgery (you'd have to wait your turn on the waitlist).

 

The same sort of principles govern radiological tests like MRI's and CT scans. If you need an MRI scan, you'll have to wait along with everyone else, depending on the urgency of your condition. However, First Nations reserves are exempt from the Canada Health Act, so any medical facilities on these lands could theoretically charge privately for medically-necessary procedures.

 

If successful in Saskatoon, this model could catch on in other areas of the country; not unlike Walmart constructing its stores on the outskirts of a town/city, and drawing a major referral base simply due to location. The logical extension of this is that you could open up a freestanding MRI clinic, or perhaps add on a few private Operating Room suites, or perhaps a private lab to help interpret your bloodwork/biopsies, or even open up a full-service hospital, located in a protected bubble on reserve lands in Canada outside the confines of the Canada Health Act.

 

Anyway, it's an interesting story for sure. Given the way our health care system is going, I'm surprised it took this long for some entrepreneur to come up with the idea.

 

Ian

 

 

www.canada.com/national/nationalpost/news/story.html?id=dc5cd1ce-8a3b-423c-bd32-89ca3cfbcde9

 

Natives plan private MRI clinic

'Tip of the iceberg': Saskatchewan band plans to build private MRI clinic on reserve, where Health Act holds no jurisdiction

 

Adrian Humphreys, with files from Tom Blackwell

National Post

 

April 21, 2004

 

A Saskatchewan Indian band plans to build a for-profit diagnostic imaging clinic on its urban reserve land, a move some say could open the door to private hospitals operating in Canada outside the control of the provincial or federal governments.

 

The 35,000-square-foot, two-storey health care centre, including 6,000 square feet for MRI and CT scans, is being proposed for a Saskatoon industrial park owned by the Muskeg Lake Cree Nation and considered an extension of its reserve.

 

The province announced it will not fund services at the clinic, despite Saskatchewan having the longest waiting periods for MRI scans in the country.

 

That leaves the Cree band reconfiguring its business model on a strictly fee-for-service model, said Lester Lafond, the band's business advisor.

 

"The province is hung up on the philosophical side of it rather than looking at the rational or innovative side," Mr. Lafond said.

 

"We are all in discussions about innovation in health care but their discussions amount to the status quo with lip service to the word innovation."

 

The Muskeg Lake Cree's plan was recently unanimously supported by a vote at the assembly of the Federation of Saskatchewan Indian Nations, which represents 74 Saskatchewan bands, said Mr. Lafond.

 

Other bands in Canada are watching the Saskatoon project for possible replication, said several native officials.

 

A renowned private clinic in the United States has also approached an Alberta Indian band about co-operating on a joint medical facility, said Assembly of First Nations regional chief Bill Erasmus, who handles the health portfolio for the AFN.

 

Because of the unique status of First Nations reserves, provincial laws on health care services and fees and even the Canada Health Act -- which enshrines the tenets of universal access to health care -- have no jurisdiction there.

 

That presents the prospect of unfettered private health care being offered on reserves close to large Canadian cities, making the Cree plan dramatically different than the approximately 30 other private MRI clinics in Canada.

 

"This is the tip of the iceberg," said Normand Laberge, chief executive officer for the Canadian Association of Radiologists.

 

"An MRI clinic is less controversial but the intent is to continue to grow and to go to an extreme, which is going to be, eventually, a private hospital, a full-service hospital, American style," Mr. Laberge argued.

 

"The issue this exposes is wider than simply another private MRI -- the consequences of this, if not not managed properly, has the potential of literally killing the public health care system, and it is happening in Saskatchewan, the birthplace of public health care," Mr. Laberge said.

 

But he said it is difficult to condemn the private plans for the province when the waiting period for an MRI is up to 22 months in Saskatchewan, a situation he called "medically unacceptable."

 

Brian Lee Crowley, president of the Atlantic Institute for Market Studies, a public-policy think-tank in Halifax, suspects the Cree idea will soon spread.

 

"Imagine if, instead of travelling to the United States, Montrealers could take the bridge to Kahanawake or some other nearby reserve; or Vancouverites could go to Indian reserves on the North Shore or in south Vancouver and visit a modern medical clinic with all the technical and other innovations that our moribund health care system can't or won't allow," he writes today on the Post's Comment page.

 

But Mr. Lafond said the sweeping visions of outside observers are nowhere in his modest plans.

 

"We have no intentions, no vision, no future discussions planned on moving away from the Canada Health Act," he said.

 

"We feel our government can operate within the Canada Health Act now and in the future, no matter what type of project we take on in terms of health care."

 

Pierre Pettigrew, the federal Health Minister, said in a speech yesterday that governments must work harder at reducing waiting lists or face increasing pressure to allow "new solutions," such as two-tier medicine.

 

"Most of the so-called new solutions aren't really so new at all," the minister said in Toronto.

 

"They are a step backward, to a time when those able to pay their way to the front of the line got the best care, and those who couldn't, did without."

 

Mr. Pettigrew said he would like to see standards that set out maximum wait times for different procedures, as well as reports indicating whether the medicare system is meeting those targets.

 

He also issued a warning about the growing practice of having the private sector deliver health services that are still paid for by the public system. The rules of medicare need to be clarified to ensure those experiments do not violate the Canada Health Act, he said.

 

Machines for conducting MRIs, or magnetic resonance images, are employed to diagnose a variety of bone and tissue diseases and cost about $2-million. A simple scan can cost about $300 and a complex one about $700, Mr. Laberge said.

 

Simple scans that do not require an injection can be done by a technician without a physician present.

 

"Most of the people in the business are saying that you can cover your costs if you do five MRIs a day," Mr. Laberge said.

 

An efficient and busy clinic can schedule 15 or even 20 scans a day.

 

Mr. Lafond said the the Muskeg Lake Cree are examining the legal and business framework for their plan, which would also provide general medical, rehabilitation and dental services for band members.

 

The Muskeg Lake Cree Nation is located on their main reserve, covering about 26,000 acres, about 100 kilometres north-west of Saskatoon.

 

The band has been buying agricultural, recreational and urban land and owns 35 acres in the eastern quadrant of Saskatoon where it has built four office buildings and a service station as part of a $20-million development, Mr. Lafond said.

[Guest moo]

There are already loopholes to the system. Rich folks will always find a way to get what they want. So now, instead of driving to the US, you just drive to an Indian reserve. To think that the Canada Health Act is fully enforceable is completely laughable.