Outsourcing CT Imaging – Brilliant, Evil or Useless?

Yesterday, John Gormley Live featured a story about the Regina Qu’Appelle Health Region requesting proposals for a third-party CT scanning center. There are currently three units in operation and a fourth unit would reduce the waiting for this treatment. Health Minister Don McMorris said that this will reduce wait times for patients. Based on the information shared, I see three possible ways to view this move.
The first way to look at this is through a political lens. One might see having services being transferred to a third party is a move towards privatizing health services. This is a hot-button issue in Saskatchewan because of our history of medicare. Minister McMorris explained that the third party would be paid by the health region and there would be no queue jumping. In addition, this is no different from medical labs and ultrasound testing providers. I feel that this is a moot point: to anybody that is waiting in line for life-saving treatment or diagnostics, how it gets done doesn’t matter. Getting top-quality, fast treatment is all that matters.
This leaves two choices, brilliant or useless. In order for this to be considered to be brilliant, one condition must be satisfied:  the increased capacity will protect or elevate a constraint.  To explain this, consider the treatment of a patient as a series of steps.  For simplicity, we will look at initial visit, diagnostic testing and treatment/surgery as the three main steps.  The increase in capacity will definitely decrease the lineup in front of CT Scanning, but will it shorten the time for patients to get treatment? There are two ways that this can happen.

The first is if CT Scanning is the constraint in the treatment process, an increase will increase the speed of treatment and reduce wait times.  This makes the move brilliant. If the constraint is elsewhere, like surgery/treatment, this won’t do much to improve patient treatment.  People will be lined up for treatment instead of CT scans.  This gets us close to a useless verdict.

Well, not quite useless.  A second way for improvement is more timely CT scans will allow for simpler, faster, more-effective surgeries and other treatments.  If treatment and surgery is the constraint in the process, this will help, but not as directly as the first scenario.

What is the goal of a health region? A good generic one is “To treat more patients better, now and in the future.”  The radio show described that that other health regions have these scanners and are not always fully utilized.  If the health regions pooled this capacity, they could get higher capacity without the third party.  This would get them closer to their goal.  If the system constraint is not CT scanning, this initiative will do little to get them closer to their goal.  If the increased scans overwhelm the ability to treat the issues, we will still be limited by the treatment step.  If treatment is the constraint, health regions need to protect and elevate that constraint if they hope to make breakthrough improvements.  I’d like to hear from health care professionals to see which scenario is the case.