Use and Abuse of Diagnostic Services: The Canadian Experience

Myrna I. Baker, B.Sc.N., M.Sc., lived and worked in Toronto.

It is most appropriate that this book, which seeks to provide insight into the status of insured diagnostic services and some of the problems attendant in their provision under the Canadian health insurance program, should be written by a man so closely linked with the field. Olding C. MacIntosh, B.Sc., M.D., CM., C.R.C.P(C.), M.R.C.Path., and a specialist in laboratory medicine, is currently assistant professor of pathology and microbiology at the Dalhousie University Medical School and associate pathologist at St. Martha’s Hospital, Antigonish, Nova Scotia. His knowledge of the area stems not only from formal training and practice, but also from some 30 years of experience as a consultant in diagnostic and laboratory services for the Nova Scotia Hospital Insurance Commission.

The first three chapters serve to set the stage by providing a statement of intent, a brief review of governmental lines of authority and legislation leading to the present health insurance system, and a delineation of what the term “diagnostic services” entails. Chapters four and five provide a more in-depth look at the history of the Canadian National Health Program and the agencies and personnel involved in delivering diagnostic services under the program. The next nine chapters are devoted to promoting an understanding of the major reasons for the astounding increases in the costs of diagnostic services, with particular emphasis on factors influencing increases in utilization.

Although there have been numerous studies of the impact of the Canadian Hospital Insurance and Diagnostic Services Act, none has focused on the provision of diagnostic services, despite spiraling demands for these services which have contributed substantially to the financial embarrassment threatening Canada’s health care system. This book is at least a beginning in filling this gap. Dr. MacIntosh writes in a style that is straightforward and free of jargon. The material in each chapter is presented in a systematic fashion, as a rule moving from the general picture of health services to the more specific standpoint of diagnostic services. References to relevant experience in Great Britain and the United States for comparative purposes add an important dimension to this work.

Those who are looking for solutions to the problems of misuse of diagnostic services must look elsewhere, for the book is based on the premise that before solutions to problems can be found, there must be a clear understanding of their cause.

In the words of D.B. O’Brien (NS Med. Bull. 33:44, 1974), “Responsibility in any field in life ... is both an imposed and acquired quality.” On reading this account of the problems inherent in the provision, expansion, use, and misuse of diagnostic services in the application of Canada’s health insurance program, MacIntosh’s message, clearly, is that responsibility for efficient and economical delivery of health services on the part of all levels of government, the medical, hospital, and allied professions, the patient and the public alike, has neither been imposed nor acquired.