Correspondence

More on Patient Access to Magnetic Resonance Imaging Centers

N Engl J Med 1993; 329:435-436August 5, 1993

Article

To the Editor:

Morgan (March 25 issue)1 concluded that despite the plethora of magnetic resonance imaging (MRI) centers in Orange County, California, access was severely limited for both Medicaid patients and patients lacking private insurance. Canada, as she stated, has fewer MRI centers than Orange County. I conducted a similar telephone survey of the MRI centers in Toronto.

Like Dr. Morgan, I asked how long it would take to schedule an MRI for a patient with a suspected brain tumor. I did not pose as a patient, but as a physician attempting to make a referral. The first center said the scan could be performed in as little as three days or as much as nine months, depending on the specifics of the case. Detailed forms would have to be filled out and assessed by the radiologist. The second center would not give me a time until the documentation was reviewed. The third center said that if the scan was urgent, it would be done as soon as possible; otherwise, it would be done in five months. The fourth center requested that a letter be directed to the radiologist.

In the second phase of the survey, I asked about the time it would take to obtain an MRI for a minor orthopedic problem. The first center said it would schedule this MRI in two months. The second center said three to five months. The third center said five months. The fourth center said that the wait depended on each case and required a letter directed to the radiologist before a date could be given.

As compared with the residents of Orange County, Canadians have greater access to MRI than Americans who lack health insurance, but less access than Americans with health insurance. This is a cost of providing virtually all Canadians with equal access to the health care system.

S.J. Weinstock, M.D., F.R.C.S.(C)
University of Toronto, Toronto, ON M5S 1E1, Canada

1 References

1. 1

   Morgan BC. Patient access to magnetic resonance imaging centers in Orange County, California. N Engl J Med 1993;328:884-885
   Full Text | Web of Science | Medline

To the Editor:

. . . The scheduling of an MRI by a patient personally, without a requisition by a physician, is extremely unusual and could have led to some of the responses that Dr. Morgan received in her various poses. Direct consultation between a physician or a member of the physician's staff and the imaging center might have had a completely different and more salutary result.

Joseph F. Kennedy, M.D.
Fertility Institute, San Diego, CA 92121

To the Editor:

. . . Dr. Morgan should know it is not that her colleagues in private practice choose to refuse MRI to Medi-Cal (Medicaid) patients, but rather that the Medi-Cal fee schedule is so low it is impossible for any entity not funded independently of insurance to accept Medi-Cal patients without risking closure.

Barry J. Sobel, M.D.
16133 Ventura Blvd., Encino, CA 91346

Author/Editor Response

Dr. Morgan replies:

To the Editor: Dr. Weinstock confirms communications I have had with directors of six of the largest MRI centers in Canada, documenting that there are substantial waiting periods in Canada, particularly for nonemergency procedures. I agree that Canadians have greater access to MRI studies than Americans who lack health insurance, but less access than Americans with health insurance. As Dr. Weinstock states, “This is a cost of providing virtually all Canadians with equal access to the health care system.” I anticipate eagerly the day when Americans will have access to health care similar to that of Canadians.

Dr. Kennedy comments that for a patient to schedule an MRI without a physician's requisition is extremely unusual. That may be true in his area. In Orange County, however, MRI facilities advertise in newspapers and specifically solicit self-referrals by patients. I inquired during my survey whether my physician needed to make the telephone call for me. I was told that patients frequently called and made their own appointments. In some cases, I was asked to bring a note from my physician requesting the study. In the few centers that accepted Medi-Cal patients, specific authorization and a physician's requisition were required.

Dr. Sobel states that the low Medi-Cal reimbursement schedule makes it impossible for a facility that lacks independent funding to accept Medi-Cal patients without risking closure. There is clear evidence to the contrary. For example, the University of California, Irvine, Medical Center (owned and operated by a for-profit national medical organization) provides imaging studies to a higher percentage of Medi-Cal and unfunded patients than any MRI center in Orange County. This MRI center is still profitable.

Beverly C. Morgan, M.D.
University of California, Irvine, Medical Center, Orange, CA 92613

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