U.S. could learn a lot from Canada about handling health policy decisions

In the world of public health--particularly as it relates to radiology--observers can be forgiven for developing a certain sense of frustration at the glacial pace at which government can arrive at sensible policy decisions.

Whether it's reimbursement issues, or self-referral loopholes, policymakers seem to resist sensible arguments and convincing evidence. That's why a recent decision by the Ontario Ministry of Health and Long-Term Care is such a breath of fresh air.

As reported this week  in FierceMedicalImaging, a study published in Radiology by a group of Canadian researchers found that direct digital radiography (DR) is more effective in detecting breast cancer than computed radiography (CR). According to the researchers, it's the first study to show a difference between these two imaging types when compared to screen film mammography. The researchers suggest that women should be informed about the potential for lower cancer detection.

While the results of the study  certainly are significant, what was particularly interesting was the response of Ontario's government to the study, which drew upon data taken from the Canadian province's breast screening program.

Based on study's the findings, the Ontario Ministry of Health and Long-Term Care decided to replace the province's 76 CR systems with DR devices. Period.

"Ontario is committed to being a world leader in cancer care, which is why our government is making changes based on this new information and the advice of our experts," Deb Matthews, Minister of Health and Long-Term Care, said of the decision.

The Ontario Association of Radiologists (OAR) has been critical of the province for not addressing this issue earlier after OAR issued a report in 2010 that underscored the need to modernize the province's mammography equipment. And while OAR argues that the health ministry should do even more than just replace CR systems (like investing in tomosynthesis, for example), the fact remains that when faced with evidence, the province made a choice to start doing the right thing immediately.

If only other sensible domestic public policy decisions could be made so quickly. For example, closing the Stark Law loophole--despite mounting evidence that it leads to unnecessary imaging and inflated health costs--has proven to be an almost insurmountable task. And physicians remain frustrated that Congress still can't find a way to permanently fix the sustainable growth rate (SGR) formula determining Medicare reimbursement rates.

So, while the Ontario Ministry of Health and Long-Term Care may have been late in addressing the province's mammography equipment needs, it has at least taken some steps in the right direction. Which begs the question: Does it really have to be so difficult to make good health policy decisions? - Mike  @FierceHealthIT

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