Reduce misuse of lab testing, urge policy experts

As health costs rise faster than GDP growth, analysts and policy experts have been looking at Canada’s healthcare system with concern. A lot of suggestions have centred on the drug space, from the generics industry’s calls to loosen protections for brand-name manufacturers to differing opinions on the need for nationwide, publicly funded pharmacare.

A few voices, rather than calling for more services and benefits for Canadians, have instead called for more rationalized spending. Among them is the CD Howe Institute, which has issued a new report suggesting that the Canadian healthcare system suffers from chronic misuse of laboratory testing procedures.

“Although the direct costs of laboratory testing represent a relatively small component of overall healthcare expenditures in Canada, the downstream effects of testing in terms of further procedures, referrals and treatments create considerable potential for unnecessary care if the initial testing was inappropriate,” the authors of the new report said.

The report cited previous research suggesting that laboratory testing rates in Canada have outpaced overall population growth and funding increases. There is also evidence, it added, that the proportion of testing that is inappropriate may be increasing over time. Interest in optimizing the ordering of laboratory tests has built up in recent years, likely because all clinical laboratories in Canada are ultimately publicly funded.

The decreased use of vitamin-D deficiency testing in Alberta is one example. Following clinical recommendations against population-based screening, the province changed requisition order forms for the test to list acceptable reasons for ordering the test; no testing would be done for any case that didn’t include any of those approved reasons. As a result, the number of tests plunged by 91.4%, representing direct annual savings ranging from $940,000 to $1.5 million.

But according to the report, efforts to detect misuse of laboratory tests have largely been held back by “barriers to laboratory data acquisition and analysis, lack of tools for detecting inappropriate testing and a lack of clarity on how to select the most appropriate utilization management strategy.” Even when clinical practice guidelines for the use of laboratory tests exist, they may vary across jurisdictions, or even among professional groups within the same jurisdiction.

The report proposed some options for policymakers to cut down on inappropriate laboratory testing, including:

• An audit-and-feedback system to ensure physicians are aware of how their ordering practices compare to their peers;
• Adjust the way physicians are paid so they are not incentivized to inappropriately call for a test;
• Make the default options for ordering laboratory tests, particularly for those with well-defined clinical applications, more restrictive; and
• Develop a provincial formulary for which tests are to be covered publicly and for what purposes.

“The implementation of this option, however, would be complex and its benefits would have to be weighed relative to the cost of developing and maintaining such a system,” the authors said of the last option.