Following extensive consultation with members, hospitals, committees of the Board and other stakeholders, the OHA has developed a position and written a letter to the Honourable Tony Clement, on the Ministry's intention to expand MRI and CT services.

In the letter, the OHA cautioned that the current plan of locating new services only within Independent Health Facilities (IHFs) would have an adverse effect on the overall system and that:
 

"Unless the expansion is properly planned, systematically implemented and effectively integrated with existing services, there is a serious risk that hospitals will lose highly skilled hospital staff to private clinics which provide high-volume, lower complexity patient care services. There is also a risk that significant inequities will also arise from queue jumping and that the increase in MRI and CT scans will significantly increase demand for other patient care services."

OHA also stressed the importance of dealing with hospital proposals for MRI and CT expansion that are currently before the Ministry of Health and Long-Term Care for approval, and made the following comments:

• Many of these hospitals have a clear clinical need and have raised funds from the community to purchase machines.
• Hospitals have a long history of raising contributions from the community to support the acquisition of new medical equipment. Because of these contributions and the ability of hospitals to integrate diagnostic testing with clinical care, hospitals have become cost-effective in providing these services.
• We should build upon the efficient and effective models of delivery, which have been proven in our hospital system.

The OHA recommended that the following criteria and principles be adopted before proceeding with any tendering process or expansion of MRI and CT scanning services:
 

1. The allocation process should not restrict the location of services to independent, stand-alone facilities. Establishing services where a hospital-based system exists will promote further integration and efficiencies, and will help to ensure that more complex scans are appropriately prioritized.
2. Priority should be given to establishing or expanding scanning services in under-serviced areas of the province or in large centres where access continues to be a problem.
3. The process should facilitate new and innovative arrangements, such as:
a. Centralizing or coordinating waiting lists with hospitals to reduce the risk of queue jumping as is currently done with Cancer Care Ontario and the Cardiac Care Network.
b. If quality control issues can be sufficiently addressed, consider introducing mobile scanning units through an existing hospital-based MRI centre as an approach to reaching patients in remote regions of the province.
c. Allocating new services to a consortium of health care providers in an area to help facilitate shared support and diagnostic services.

4. All proposals must include human resource plans demonstrating that any new staffing and recruitment strategies will not adversely impact existing hospital services.
5. All bidders must clearly demonstrate how their proposals will be integrated with other health care services in the system, including, but not limited to, the sharing of patient information, diagnostic results and clinical referrals.
6. All MRIs and CT scanning machines should meet minimum provincial quality standards and should follow strict accreditation standards and patient safety best practices.
7. Given the importance of these diagnostic services to patient care, the awarding process must be fully transparent to the public and must improve the quality, accessibility and sustainability of our health care system.

The OHA requested an opportunity to discuss the issue further and offered to participate on an advisory panel to assist the Ministry in its deliberations. Thank you, to those members who took time to assist us in the formulation of this position. For additional information, contact Marty Gurbin, Sr. Economist, at 416-205-1388 or email mgurbin@oha.com