Unequal access to MRIs

TheStar.com – Opinion/Editorial – Unequal access to MRIs
March 04, 2009

Equal access for all. That fine principle underlies our publicly funded health system. Yet well-to-do Canadians somehow manage to get more care than others.

The latest evidence is a study from the Institute for Clinical Evaluative Sciences (ICES) showing that Ontarians in affluent neighbourhoods have greater access to MRI diagnostic scans.

These findings should ring alarm bells for anyone concerned over the lack of equality in health care. But during question period in the legislature yesterday, Ontario Health Minister David Caplan brushed the study aside. “I certainly welcome the findings of the report,” said Caplan, “. . . because it highlights that we have, as a government, made the right investments to double the capacity for magnetic resonance imaging in the province of Ontario. . . . The report makes it very clear that we are on the right track.”

Few reading the ICES report would agree with Caplan, especially not low-income Ontarians.

Caplan was hanging his response on the fact that MRI usage has more than doubled across the board in Ontario, thanks to an investment of at least $118 million and the installation of 16 new scanners since 2003. But the ICES study set out to find who benefited from that expansion.

Analyzing MRI billing data since 2002-03, researchers found that the incidence of MRI scans was initially 25 per cent higher in affluent neighbourhoods than in low-income areas. After five years of expansion, everyone received more scans, but those in affluent neighbourhoods were 38 per cent more likely to get one.

It’s not because the affluent are sicker. If access were truly equal and based entirely on need, low-income Ontarians would likely receive more scans, as they generally carry a greater burden of disease.

There was some speculation that the affluent might be more prone to certain medical conditions requiring an MRI, but the study’s authors concluded that this was not the case. “Indeed,” they wrote, “the argument could be made that conditions such as back and knee pain might be more common among people living in lower-income neighbourhoods.”

What is the explanation, then? It isn’t clear. A subtle class bias on the part of doctors may be a factor. Perhaps the affluent are more knowledgeable about various medical treatments available and, therefore, are more likely to pressure their family doctors into prescribing MRI tests. Or maybe low-income Ontarians are less likely to have access to a family doctor to begin with. The study suggests low-income patients are also less able to travel to MRI appointments or take time off work for them.

Yes, residents of low-income neighbourhoods are receiving more MRI scans than five years ago – 80 per cent more, as Caplan points out. But the affluent have enjoyed a 102 per cent increase in MRI usage, and they started from a higher base.

That pattern flouts the principle of a universal health care system, with equal access for all.

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