More MRI cash helping rich more than poor, study finds

From EndCanadianPoverty.ca

• Date: March 3rdh, 2009
• Source: The Globe and Mail
• Link to article: Female drug users face unique, serious health effects: researcher

"TORONTO — An infusion of cash to cut long MRI waiting times has doubled the number of the annual diagnostic scans performed in Ontario since 2004, but the increase seems to be benefiting wealthy patients far more than their poorer counterparts, a study has found.

When the study started in April of 2002, patients living in the richest one-fifth of the province's neighbourhoods were 25-per-cent more likely to receive magnetic resonance imaging than those living in the poorest one-fifth of neighbourhoods.

Yet, even after Ontario invested $118-million in 2004 to shorten waiting times, it did little to narrow the gap between rich and poor. In fact, access disparity actually widened over five years, with the wealthiest patients being 38-per-cent more likely to get an MRI than the poorest.

"One would hope that if you're investing that significantly that you can double a capacity to do MRI scans, that you would narrow that gap and make some impact on it," said Dr. John You, principal investigator of the 2002-2007 study by the Institute for Clinical Evaluative Sciences.

"But, in fact, it's the opposite that's happened. And to me, that's the most concerning part of what we've found."

Dr. You said people with lower incomes tend to have more health problems, on average, than those with higher incomes and often of a more serious nature. Yet many studies have shown that those with fewer financial assets also have difficulty accessing all kinds of health-care services compared with the better-off.

"The staggering thing is that this is not like it's in the United States where there are big issues around the uninsured," Dr. You said. "This is in a country, or a province, with universal health insurance. So why should there be a gap in access when everyone has the same kind of insurance coverage?"

The study's authors speculate on a number of potential reasons for the rich-poor gap.

"It may be that wealthier individuals are more adept at navigating the health-care system," Dr. You said. "They're perhaps a little bit more insistent with their care providers that they get the test they think they need. And there's very little incentive for the physician to say no because they're not paying for it and the patient's not paying for it."

Those in lower income brackets may not be quite as aware of how to finesse the system and get what they want or they may not be as educated about MRI scans and their uses, he said.

The study authors say more research is needed to determine why income seems to make a difference in getting an MRI before attempts can be made to close the access gap.

Dr. You said doctors may be ordering more MRIs that are medically unnecessary or inappropriate and strategies are needed to reduce this overuse.

He suggested that lengthy guidelines for appropriate MRI use, put out by the Canadian Association of Radiologists, be made easier to use for busy physicians, perhaps by making them Web-based.

But Dr. You said the biggest challenge may be changing how the public and doctors view high-tech imaging.

"I think our tendency, myself included, is to get mesmerized by the beautiful pictures that the machines make and the amount of detail you can get from them. And you kind of forget to look at it in an objective way, to see if the test is actually useful for your patient."

"There is a tendency for many of us to equate really fancy tests or expensive tests with better care. And I just don't think that's always true."