Alberta allowing patients to self-refer, pay for tests

CALGARY – The Alberta government is following through on its plan to introduce a self-referral model of preventative medical testing whereby patients can pay out-of-pocket or via private insurance in an effort to cut into lengthy waiting lists. However, critics say it will only benefit those with money to spend and may further burden the public system.

The plan was first announced last October through a social media video and was put into legislation in the spring that reclassified preventative health testing as uninsured under the public system.

At a news conference in Calgary on Monday, premier Danielle Smith (pictured) said the policy is intended to complement the public health system and expand patient choice while enabling earlier detection of disease.

“Early diagnosis makes everything easier. Treatment is simpler and more effective, and it places fewer demands on the healthcare system,” she said.

“An individual will have a pretty good idea whether something’s not quite right with them, and in some cases, they’ll be able to work with their practitioner to get the test that they need.”

The new policy will come into effect on Friday, the Edmonton Journal reported, and it will allow individuals to self-refer for certain types of testing — magnetic resonance imaging (MRI), computed tomography (CT), ultrasound, and X-ray scans. That list does not include blood work as indicated in October’s video, though the province said the list of eligible tests could be added to in the future.

The government says patients who pay for their own testing could be reimbursed if the results lead to a clinical diagnosis of cancer, the lone disease the policy applies to.

Primary and Preventative Health Services minister Justin Wright said the province expects physician-referred services will be delivered first.

“These testings will take a secondary priority,” he said.

All tests ordered by a healthcare provider will remain covered across both public and private providers and the changes do not apply to existing preventative screening programs such as those for breast, cervical, or colorectal cancers, which will continue operating unchanged and be publicly paid for.

Individuals are eligible if they are 18 years of age or older, or under 18 years of age with consent from a parent or guardian. Residents from other provinces can also access the new testing regime though they are not eligible for potential cost compensation.

Albertans would have one year from the time of the test to complete a reimbursement form which the province says it aims to turn around within six to eight weeks.

Private providers can choose whether or not to participate in the new testing system and can also set their own rates. The province said it can’t yet say how many providers will opt-in but that it expects it to be a rolling decision made by individual facilities.

Albertans can currently access preventative health testing services at no cost following a referral from a provider such as a physician or nurse practitioner. Such a referral is also currently required to access services at private diagnostic imaging clinics.

Prime minister Mark Carney has been largely silent in response to claims that Alberta’s plans will run afoul of the Canada Health Act and threaten public access to healthcare.

His office deferred a request for comment from Postmedia to that of health minister Marjorie Michel, who provided a statement saying the federal government’s focus is to protect the integrity of the public health care system and ensure all Canadians can receive care without having to pay for it.

“We have taken a collaborative approach with all provinces and territories, including Alberta, that respects their jurisdiction to explore innovative ways to improve access and care while protecting the public, universal healthcare system,” it reads.

“A collaborative approach between our governments has always produced strong results for all Albertans and we will continue to work in that direction.”

Alberta Opposition primary and preventative health services critic Sharif Haji said in a statement the new plan will leave those unable to pay waiting even longer than they currently do.

“Albertans are already struggling with the affordability crisis, and many families simply can’t afford to pay out of pocket for essential health care,” he said.

“This will only drive wait times higher and force more people to live in pain and suffering while they wait for the care they need.”