Introducing an integrated imaging delivery system in Manitoba

Abstract

Objective: As a result of the reform of a comprehensive government health plan, an integrated imaging system is being created in the province of Manitoba. The intent of the system is to reduce costs, avoid causing harm to patients, enhance physician referral services and add new programs.

Methods: Evaluation of trends in examinations, equipment, personnel, expenditures and policy in the 1992-93 and 1995-96 fiscal years in Manitoba.

Results: The population has remained steady, at 1.1 million. Hospitals have been amalgamated under new authorities, and Manitoba's annual health care spending of $1.8 billion has been reduced by $235 million. Between the 2 years, use of radiography declined from 835,748 to 726,394 examinations per year. Use of mammography, ultrasonography, computed tomography, magnetic resonance imaging and nuclear medicine increased moderately. The total number of radiologic examinations declined from 1,069,579 to 975,044. There was little change in equipment, but the plant aged as a result of freezes on construction and capital spending. Personnel declined by 20 full-time equivalent positions, from 794.3 in 1992-93 to 774.3 in 1995-96. Savings in operations were made as a result of hospital budget restrictions. Total expenditures declined from $100 million to $89 million. The income of imaging specialists did not change because they were paid higher fees for examinations involving newer technology.

Conclusion: Integration of rural/northern and urban hospital services has followed the plan set out in recent legislation. Savings of up to 20% are expected to be realized through reduction in personnel (saving $1 million), group tendering ($1 million), in-house repair ($1 million), reduction in deployment of equipment ($3 million), integration of services ($1 million), indirect cost reduction ($5 million), practice guidelines ($3.5 million), reduced breast screening costs ($1 million), physician payment reform ($1 million) and rigorous clinical/fiscal audit ($1 million).