Alberta’s plans to regulate, oversee and evaluate its new rules that allow residents to privately pay for certain medical tests fall short and may benefit private investors over patients, health care experts warn.** **

Starting Friday, Albertans can purchase MRIs, CT scans, ultrasounds and X-rays through private providers without a doctor’s referral, a model unique in Canada. Premier Danielle Smith said Monday that the program will lead to earlier cancer detection and support the public health care system.

The government first announced its plans for private, self-referred medical tests last October, drawing widespread criticism, including from health coalitions, medical experts and opposition politicians. Critics argue it will create a two-tier health system, increase demand for unnecessary tests and could worsen public wait times.

Ms. Smith outlined some changes to the original plan on Monday. Only tests that result in a cancer diagnosis will be reimbursed by the province, rather than for any “significant or critical condition.” Additionally, blood work is no longer included.

The update did little to quell concerns.

Beginning Friday, Alberta will open up its diagnostic medical testing by allowing people to bypass medical referral for tests like an MRI or an ultrasound with patients paying out of pocket and a potential for reimbursement.

The Canadian Press

Family physician Lee Green, who is a professor of family medicine at the University of Alberta, said peer countries that offer private medical testing are closely regulated, but there is a “lack of attention” by the province.

“I have some concerns about whether this is a stalking horse for investors as opposed to real patient benefit,” Dr. Green said in an interview Tuesday. “And what concerns me most is that I don’t see the pieces in place to get those answers.”

Ms. Smith’s United Conservative government has leaned into the private industry through its overhaul of the provincial health system. Later this year, Alberta doctors will be allowed to work simultaneously in the public and private systems, something no other Canadian province permits.

The Premier defended the private testing model Monday as a way to put power into the hands of individuals, referring to it as “peace-of-mind testing.” Under the new rules, private clinics will set their own prices for permitted diagnostic tests and the government will reimburse scans and tests at prescribed rates, which will be published Friday.

Dr. Green said a timely and proper evaluation must be done to determine the effectiveness of this policy and whether it has any unintended consequences.

He added that allowing Albertans to self-refer for medical tests is a “solution to a problem that doesn’t exist.” He said people are having trouble accessing MRIs not because of physician referrals, but because health resources are limited.

Still, those without a family doctor are typically younger and healthier, live in underserved rural areas or are medically complex patients, Dr. Green said. But these groups often cannot afford to pay out of pocket for services, which he said raises the question of who will benefit from the private-access model.

“It’s one of those situations where the devil’s kind of in the details, and I think there are some reasons to think it’s a good idea and some reasons to have some concerns about it,” Dr. Green said.

In March, the Alberta Medical Association released an environmental scan assessing the benefits and risks of self-referred, private-pay diagnostic imaging and screening services.

It concluded that a lack of standards and oversight is associated with “risks, limitations, system-level concerns and patient harm.” Additionally, while private outsourcing may offer short-term relief, the association said international evidence suggests it will not meaningfully reduce wait times or alleviate public-system pressures.

Brian Wirzba, president of the association, said they provided the environmental scan to government and also raised questions about what metrics will be used to measure the impact of the program and its effect on the public system. He said they “never got really good answers” back.

“As a profession, we support innovation, but this goes against basic evidence-based medicine principles and has major risks for further cost overruns and negatively impacting access in the public system,” Dr. Wirzba said Tuesday.