Who is Eligible for PET Scans in Ontario?

When government insistence on cutting costs runs up against increasingly technologically advanced modern medicine, the resulting tangle of public health regulation can be just as complicated and unhelpful as the convoluted policies of any private health insurance company. An excellent example of this is the current situation for Ontario residents seeking PET scans. I'm providing this page as a guide for Ontario residents and an illustration of medical rationing gone mad.

PET scans, including combined PET/CT scans (the current standard of care), are an important tool in detecting, staging, and restaging many types of cancer, including lymphoma. PET scans may use a mildly radioactive tracer molecule, like FDG, which is absorbed in the body like sugar. Cancerous cells tend to demand more than their fair share of sugar, so they light up on the PET scan. Or they do in some provinces, anyways. According to the Canadian Agency for Drugs and Technologies in Health (CADTH), Quebec, with a population of about 8 million, conducts 21,000 PET scans a year. Ontario, with a population in excess of 13 million, funded just 2000 PET scans a year, although that number is probably now increasing substantially thanks to new funding provisions.

In the Ontario provincial healthcare system, there are several methods for qualifying for a PET scan from PET Scans Ontario. The bright side is, there's no waiting list. Unfortunately, that's because PET scans are strictly rationed. Only one of the criteria is directly relevant to lymphoma patients, and it includes only some lymphoma patients:

Better off in BC? New Cancer Care Comparisons

The Lancet is publishing a new survey of cancer care outcomes in six countries -- Canada, Australia, Denmark, Norway, Sweden, and Britain -- between 1995 and 2007 (report here; registration is required, but free). It's not of direct relevance to Northoma, because the statistics in question don't include lymphoma. However, it's always helpful to understand how Canadian healthcare compares to systems in other countries. Frustratingly, the United States was not part of this data set. I'll write more about that particular comparison later.

In the meantime, how did Canada measure up?

Navigating Canada's "Postal-Code Lottery"

So far my little handful of posts have been confined to various minor and general issues, but the real purpose of this blog, as I envisioned it, was to help people understand this particular corner of the labyrinthine bureaucracy of the Canadian public healthcare system. Until you have a serious illness (or fear you have one, anyway), the Canadian universal healthcare experiment can look like a grand success. In many ways, it still is: spending half what Americans do per capita on healthcare, we still achieve comparable results in terms of survival rates, and superior results in life expectancy.

At the same time, our bureaucratic morasse is creating many more problems than it solves. At the beginning of the year, the Cancer Advocacy Coalition denounced the multitude of different provincial regulations for cancer treatment as a "postal-code lottery": Canadians get different treatment depending on where they live. There are reasons for this, and I hope to explore them later on. For the moment, let's accept that it's true – and that I'll try to help people understand where they fit into that lottery over the coming months.