The recent announcement that a new diagnostic centre will be built at the Heritage Centre in Niverville has generated spirited debate.
The community-based, innovative effort to expand MRI, ultrasound, X-ray and laboratory services is modelled after Niverville’s community-built and -owned 80-resident personal-care home. This model was supported by the previous NDP government in 2011.
The diagnostic centre will help address unreasonable wait times Manitobans face for MRIs.
The effort will neither be private nor public, but a “third way.” This innovative, common-good model is made possible through a collaborative agreement between the Heritage Centre, the Town of Niverville and private partners.
Tommy Douglas, the father of Canadian medicare, outlined that universal health care consists of two stages. The first stage is universal access to emergent, urgent and doctor care. The second stage, which Douglas felt was most critical, was “preventive care.” He stated medicare is not sustainable without this second stage.
As patients, health-care providers and governments, we have failed to heed Douglas’s declaration.
Niverville’s “third way” addresses Douglas’s prophetic words about the second stage. By overseeing the private partners’ efforts to build the diagnostic centre at the Heritage Centre, our community is able to frame this “third way” collaboration. Included in this agreement is a “public-private-partnership” arrangement in which the diagnostic centre is donated to the Town of Niverville after 25 years — ensuring public interest and ownership is achieved.
Some will claim the public interest is not served by receiving an “old building” and “used equipment” after 25 years.
The legally binding agreement ensures the custom-built commercial building and advanced diagnostic equipment will not only be in good condition, but have many years of remaining life when donated to the town.
This “third way” creatively enhances the sustainability of Canada’s health-care system by addressing Douglas’s second plank.
The collaborative agreement calls for the creation of Heritage Life Community Health Services. This new not-for-profit entity will enable the Heritage Centre to facilitate all MRI orders. Through this unique arrangement, all MRIs will be arranged through the Heritage Centre as a third party, which is consistent with and allowed for in provincial legislation. This will provide Manitobans the option, with a doctor’s requisition, to self-select an MRI either in Niverville or within the public system.
Manitobans already are self-directing their diagnostic needs by travelling to North Dakota for MRI services. Having an option closer to home will result in greater economic activity for the province. Critically, it will generate new income taxes, boosting the government’s ability to support our health-care system.
This “third way” also supports Canada’s Health Act accessibility provision. MRI fees in Niverville will be based on income, assisting those facing economic barriers who wish to self-direct their diagnostic needs. MRIs will be discounted by 25 per cent for families whose income falls within Manitoba’s lowest income-tax bracket.
For those who qualify for a full discount at the diagnostic centre, the fee will be $750, the approximate base cost of providing an MRI in Niverville.
Manitoba’s auditor general recommended in spring that the current practice of third parties, such as the Worker’s Compensation Board (WCB), bumping patients on current MRI wait lists should stop. The Heritage Centre Board agrees. Niverville’s new diagnostic centre will allow insurers such as WCB a reasonable option to access MRIs outside the public system. This would open up some 2,500 MRI spots at Pan Am clinic immediately, reducing its 29-week wait list.
To be sure, some will state this community-based, innovative “third way” is a step toward United States-style health care. It is not.
Niverville’s initiative is seeded and vested in a community-based, not-for-profit social enterprise for the common good. Evidence-based outcomes in public health care make it clear more government expenditures will not address current challenges. We require greater innovation, community-based initiatives and a keen focus on medicare’s second stage to reimagine and improve an ailing health-care system.
This innovative initiative ensures public ownership, over time, of the diagnostic centre. It provides reasonable accommodation to Manitobans seeking self-directed diagnostic services. It offers the possibility of immediately reducing current MRI wait times. Finally, it creatively ensures economic accessibility to Manitobans through an income-tested fee schedule.
Douglas often said, “Courage, my friends; ’tis not too late to make a better world,” as he passionately campaigned for medicare in the 1960s. Niverville’s “third way” approach is courageous and will lead to a better world for Manitobans as we strengthen universal health care in the 21st century.
Gordon Daman is a volunteer board member on the NHHI Board of Governors, which provides governance for the Niverville Heritage Centre. The centre is a not-for-profit community owned social enterprise campus that provides various community, social and seniors housing services for Niverville and region.
There is an adage: if it sounds too good to be true, then it probably is.
This certainly seems to be the case with Niverville’s recent announcement that the town hopes to partner with a private holding company and build a user-pay MRI clinic in the community.
The investors are billing it as “an innovative community response for the common good.” They claim when some of us pay, MRI wait times for everyone will go down. And profits and investment will be kept here in Manitoba, rather than trickling down to North Dakota.
That all sounds wonderful, doesn’t it? But only if you don’t think about it too hard.
Let’s start with claim No. 1: according to the Canadian Foundation of Health Care Improvement, countries with both public and private health-care systems always have the longest wait times. England and New Zealand, for instance, which have both public and user-pay hospitals, have longer wait times in their public systems than medicare systems such as ours.
This backs up evidence found here in Manitoba decades ago. Until 1999, cataract patients could choose to have their surgery at a private clinic by paying a user fee. While the fee was in place, Manitoba researchers found that patients whose surgeons worked in both public and private clinics had to wait 16 weeks longer — 26 weeks versus 10 weeks — than those whose surgeons practised only in the public system.
Turns out this was largely a staffing issue: there were only so many surgeons, and people can’t be two places at once.
The same goes, of course, for Manitoba’s radiation technologists. These highly trained people who run the MRI machines are already in short supply.
And if demand for privately paid scans is as high as advocates say it is (and the Niverville investors are banking on), then the technologists who perform scans for the private clinic inevitably will have to come from the public system, driving up wait times for the rest of us.
That bring us to their second claim: some people are already paying south of border to jump the queue. Why not keep that money here to make a few Manitobans richer?
The answer is because their profit-driven idea will not only increase diagnostic wait times for average Manitobans, it actually will allow the provincial Tory government to ignore solutions right under its nose.
The Dauphin hospital, for instance, already has completed an addition intended to house the first MRI in Manitoba north of the Trans-Canada Highway.
Staff already have been trained. Rural residents as far as The Pas finally are set to access diagnostic services that don’t require travel two days away from home. All that’s needed is the machine itself, already paid for and sitting in Germany, waiting to be shipped and installed.
In March 2017, however, the whole thing was put on hold by the government, which stated its Wait Time Task Force required at least a year of “further study.”
You don’t need to live in Dauphin, or work in the health system, to imagine what this delay is costing Manitobans like you and me, both in dollars and wait times. So why isn’t the Dauphin MRI up and running?
I sure hope it’s not because they’re buying the Niverville investors’ claims — “we can help those with cash get diagnosed first, reward a few savvy business people and save medicare, all at the same time!”
And I sure hope it’s not because they’re considering investing our tax dollars in supporting and sustaining a profit-driven approach to health care that will not even come close to benefiting all Manitobans.
The vast majority of us say medicare — a system in which no matter who you are, or where you live, your access to health care is based on need and not the size of your bank account — is our most cherished public service. Most of us say it’s our most cherished thing about being Canadian. Even with our system’s challenges, it seems watching the United States debate about health care is enough to remind us that what we’ve built is precious, and worth fighting for.
The reality is that what would benefit all of us most right now is embracing solutions that are both ready to roll and addressing wait times within our much-valued universal system, as in Dauphin, or investing in more trained radiation technologists.
Let’s not get sidetracked by investors whose claims are simply too good to be true.
Michelle Gawronsky is president of the Manitoba Government and General Employees Union.