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Canada should look to U.S. for health reforms

In the United States, nine physician groups have identified 45 tests or procedures that are commonly used, but are of no proven medical benefit. It's a refreshing take on a tough debate, from which Canadian physicians should draw inspiration.

Some lists include the obvious, such as antibiotics for uncomplicated sinus infections almost always caused by viruses. But other items identified are more surprising: imaging of the lower spine within six weeks after suffering back pain, for instance, and routine chest X-rays for ambulatory patients before surgery.

The exercise follows an article in The New England Journal of Medicine that was critical of medical groups during U.S. health-care debates for being too concerned with protecting their incomes. The author, Dr. Howard Brody, urged each specialty society to develop "top five" lists.

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The physician groups, which include family doctors, cardiologists, radiologists and oncologists, obliged by considering what would quickly save the most money without depriving patients of what Dr. Brody described as "meaningful medical benefit." Some of the top five lists were published this spring; eight additional societies are expected to release theirs next fall.

In Canada, health reform has largely been the purview of provincial governments trying to get their fiscal houses in order, and often places those governments directly at odds with doctors. The most notable changes of late have come in Ontario, where the government has lowered the fees of specialists to reflect technological advances that have made tests or operations quicker and (in some cases) easier to perform, while limiting the number of diagnostic tests and other services that it thinks are being referred too frequently.

Those changes have led the Ontario Medical Association to issue dire warnings of service cuts, and of physicians fleeing the province. But one way or another, governments will continue to move toward "evidence-based" care, as they seek to ensure the sustainability of funding. Doctors in Canada would be wise to follow the lead of their counterparts south of the border, and help lead the discussion.

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