Docs more likely to make unnecessary referrals when they have ownership of the diagnostic service — study

There is a considerable body of evidence to suggest more investor-owned private delivery of public health care will increase costs and leave the government paying for unnecessary services.

The latest evidence comes from a Duke University study presented at the Radiological Society of North America this week.

The Duke University study reveals that doctors who have a stake in MRI (Magnet Resonance Imaging) scanners are far more likely to refer patients for scans.

Among doctors who owned or had a share in MRI scanners, 42 per cent of patients had negative scans, compared to 23 per cent who were referred by doctors who had no stake in the equipment.

The doctors with a financial interest in MRI equipment were also much more likely to send younger patients to be scanned, the average age being 49.6 compared to 56.9 for doctors without a financial interest.

The US Government Accountability Office (GAO) has been trying to rein in the number of self-referrals after imaging services performed in-house rose from 59 per cent to 64 per cent between 2000 and 2006. Money generated from privately-owned diagnostic equipment makes up an increasing share of doctor’s income in theU.S.

According to NPR Health Blog, in 1990 the U.S. GAO found that Florida doctors ordered three times as many MRIs, twice as many CTs, and five times as many ultrasounds if they owned a piece of the imaging service.

DukeUniversity’s Ben Paxton, in presenting his study, said tougher state and federal disclosure laws are required for physicians who own or have a share in labs, radiology clinics and other services.

Here in Ontario there is no such public disclosure of which doctors have shares in private labs and other diagnostic services which conduct OHIP-paid work.   

Despite international evidence like this, Don Drummond is expected to make private delivery of public health care a significant recommendation in his Commission report on the reform of public services expected in January.