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TECH/POLICY/INTERNATIONAL: Canada is more efficient user of MRIs compared to U.S., U.K.

Ian Morrison said in his talk at the P4P conference the other day that no Canadian had ever had an MRI. As a sweeping generalization that’s true. But in actual fact a few of them have had one, and they use their machines a lot more efficiently.

(BTW Ian was joking, for you literal conservatives out there).

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Edward P. Grace, M.D.The Medical Blog NetworkHarveyNaive CanadianTraier K. Michael Recent comment authors
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Edward P. Grace, M.D.
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Edward P. Grace, M.D.

Please let me know if it is wise to open an MRI center in Canada? Thanks

The Medical Blog Network
Guest

You nail it, Trapier.
I would like to hear Matthew explain why “there [should not be] compromises between the opulence [means US] and utter poverty [means Canada] of healthcare quality?”
A real marketplace would have a smooth scale with consumer choice, while government taking care of the universal baseline.
Is there any reason why it is not possible?

Trapier K. Michael
Guest

You’re absolutely correct Harvey! How silly is it that the only choices available to consumers are ‘feast’ or ‘famine’ such that one can go from “Bentleys to…dying in the street,” as Matthew says?
But Matthew is absolutely correct. Such is the reality of our current medical marketplace.
So where are the healthcare Hondas? Why is everything a medical Mercedes? In a time when “rampant, rising costs” is the rallying cry of health policy reformers, why isn’t everyone aghast that there are not compromises between the opulence and utter poverty of healthcare quality?

Harvey
Guest

I’m disappointed that everyone has so easily accepted the proposition that Efficiency is the only desideratum of medical care. Shouldn’t we give SOME consideration to Patient Outcomes? How many patients waited how many weeks in pain because they couldn’t get a prompt diagnosis? How many had cheaper procedures which failed to give correct diagnoses? And even in economic terms, how many of the expenses were externalized to the rest of the economy, in terms of lost time on the job, disability payments, etc.? Mere “efficiency” could be maximized by firing all doctors but one, selling all x-ray machines but one,… Read more »

Naive Canadian
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Naive Canadian

Re: “…so I guess everyone can be happy!” Not so fast, Matthew. I’d like to have a word with you, if I may. I’m quite excited by your assertion that Trapper’s “theoretical BS” is trumped by “the Canadian reality.” Does that mean that if The Canadian Reality turned out to be a Massive Myth of Moose-Like Proportions, that you would surrender your case? Would it spell an end to the US vs. Canada nonsense that you call a debate? What would happen if someone could demonstrate to you that the Canadian system is not “efficient” – in either your “sense”… Read more »

Traier K. Michael
Guest

I have been bested at my own game!! Kudos.

Matthew Holt
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Matthew Holt

Well apparently Paris Hilton does indeed have marginal utility, so I guess everyone can be happy!

Trapier K. Michael
Guest

In the absense of peer-review practices on the blogosphere, I’d like to submit the “Google” theory of intellectual value.
Compare the returns you get by Google-searching the key terms of my arguments – ‘marginal utility,’ ‘demand function,’ ‘equations’ – to what happens when you search for “Paris Hilton” and “Bull S#@t”.

Matthew Holt
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Matthew Holt

BS is code Trapier. Meanwhile, even if we had the perfect market on the payment side, the imbalance of information and the uncertainty of outcome means that we cannot fathom out what real value from the MRI will be. You may think it’s OK to leave it to whether someone can afford it or not, but that means we’ll end up distributing MRIs (or care) in the same way we do ith Bentleys or Coach handbags or whatever else Paris Hilton can afford but you or I can’t. As a practical matter, we’re not prepared to do that with health… Read more »

Trapier K. Michael
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Re: “BS”
Huh. I always thought “Liar, Liar, Pants on Fire” was the rebuttal of choice in second-rate economic parlance.

Trapier K. Michael
Guest

Re: “And it really tweaks your noses that the possible scenario we have here of unlimited payment for imaging from unquestioning third party payers might not be as good a solution as Canada’s constrained supply for large capital items. Even though all three of you actully OPPOSE such an unlimited third party payment system. And that under your idealized “consumer pays for more or less everything out of pocket” they’d be a hell of a lot less MRIs around here.” For anyone still with me on this…here’s an answer to this very good point Matthew makes. Just as the artificial… Read more »

Matthew Holt
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Matthew Holt

BS. Most economists view efficieny as a measure of productivity given a pre-determined input (e.g. unit labor cost). You are talking about maximizing utlility, which cannot exist as an economic concept outside of a free market that approaches the rule for perfect competition, which as you well know cannot exist in healthcare — because it’s damn near impossible to measure the “value” on the right hand side of equation #3.

Trapier K. Michael
Guest

Re: “Let me expalin econ 101 to you. Per $ spent on MRI machine, Canada is getting more out of them. That is the economic definition of efficiency.” No. no. no. The economic measure of efficiency is cost compared to benefit; more technically, MRIs can be called “efficient” on the margin if, in the ‘short run’, [1] MC = or < MU (in other words, marginal cost is equal to or greater than marginal utility). In this 'short-run' you ignore fixed costs. In the 'long-run', however, costs formerlly known as 'fixed' beceme 'variable' and factor in Equation 1 above. How… Read more »

Matthew Holt
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Matthew Holt

This is a blast at the three of you, excepting Greg. Yup Canada probably was more efficient 5 years ago. I reccomend the lot of you get jobs in the airlines and suggest to them that they fly more planes at a lower load factor, and see how long you last with your idea of “efficiency”! Let me expalin econ 101 to you. Per $ spent on MRI machine, Canada is getting more out of them. That is the economic definition of efficiency. And it really tweaks your noses that the possible scenario we have here of unlimited payment for… Read more »

John C
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John C

Matt, bad example. Assuming demand is constant limiting supply while increase the utilization per unit no matter if you measuring MRI, CT, or gas stations. So they have fewer machines and the machines are used more often. This doesn’t tell me anything about efficiency. From a purely production standpoint, i doubt that a Canadian MRI actually takes less time than a UK or US MRI. The technology is the same. I wonder why they didn’t compare wait times for imaging across the 3 countries? Ooh, that’s right, that would make the US look good…and who wants that to happen 😉… Read more »