The Alberta government is proposing expanded access to self-referred, private-pay diagnostic and laboratory testing. This means Albertans could pay out-of-pocket for screening MRIs, CT scans, and lab services, without needing a physician to order the test.
Many Albertans want faster answers and more control over their health decisions. Removing referral requirements may seem like a quicker, more convenient way to access testing.
What happens after you receive your results? While some findings are straightforward, many are not and can be difficult to interpret without medical guidance.
Test results can reveal something unexpected, harmless, or sometimes serious. Without a doctor’s expertise to help you understand your results, they can raise a lot of questions without clear answers.
In health care systems around the world, physician referrals are a vital part of the process when a diagnostic test is ordered. Doctors assess whether testing is appropriate, interpret results and guide patients through next steps.
Physicians carry a duty of care, meaning they are responsible for reviewing results and ensuring appropriate follow-up. This helps patients avoid unnecessary anxiety, missed diagnoses or inappropriate care.
The government has indicated that if a test uncovers a life-threatening condition, patients may be reimbursed, however it is not yet clear what tests patients might be reimbursed for.
And sometimes tests don’t give clear answers. They lead to more tests, more appointments and even treatments, frequently finding that nothing was wrong in the first place. This creates added anxiety and stress for patients while also putting unnecessary pressure on Alberta’s testing systems, our health care workforce and the public system we rely on.
While initial self-referred testing may occur outside the public system, the resulting care does not. The cost of a doctor reviewing the results, repeat testing, referrals to specialists and treatment planning all add up, increasing the cost to the public system. Expanding access to testing can strain diagnostic services and public resources, especially when follow-up care, physician consultations, repeat testing and specialist referrals are required.
Even if an individual pays out of pocket, there are downstream impacts to the health system.
In health care systems around the world, physician referrals are used to make sure testing is appropriate, and that someone is responsible for helping patients understand their results and next steps in their care journey Where self-referred private pay access is available, there are strict guidelines and regulations in place.
International evidence indicates that enabling self-referred access for screening tests hasn’t resulted in meaningful reductions to wait times or lessened the burden on the public system.
Even modest increases in testing volumes can cascade into significant additional provincial spending most clinically relevant findings would come to light with evidence-based routine screening.
Estimates show that allowing for self-referral and private payment for diagnostic screening services in Alberta could increase costs to the public health system by approximately $784 per test. Management of positive findings from such tests - including findings that result in no real health concern - will add approx. $1M annually.
Without appropriate clinical oversight, increased use could contribute to ballooning provincial health care expenditures while diverting limited resources away from patients with more acute, urgent or complex needs.
Self-referred testing may improve short-term access, but it does not necessarily mean faster or better outcomes for patients. It also carries serious implications for provincial health care spending and could escalate into millions of dollars in unnecessary downstream costs. Expanding access must therefore be balanced with responsible use and a clear understanding of the health care system designed to deliver appropriate, efficient and high-quality care for Albertans.
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