🤔 Ever wonder why certain medical tests are overused while others with better evidence are harder to access? It’s not always about science—it’s about how we pay for healthcare. Reimbursement models shape practice patterns more than we realize. 🧵 #medsky - ThreadSky

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andyszavakovats.bsky.social • 9 days ago

🤔 Ever wonder why certain medical tests are overused while others with better evidence are harder to access? It’s not always about science—it’s about how we pay for healthcare. Reimbursement models shape practice patterns more than we realize. 🧵 #medsky

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andyszavakovats.bsky.social•9 days ago

🇨🇦 🫀 Take cardiac risk stratification in Alberta: MPI is widely available, while CTCA has long wait times. Why? MPI is insured under the SOMB, meaning private clinics can bill the gov’t. CTCA, like all CT/MRI, is rationed by hospital-controlled slots. Policy, not evidence, drives access.

andyszavakovats.bsky.social•9 days ago

🦴 This happens outside cardiology, too. In suspected osteomyelitis, MRI is cheaper & better for most cases, yet we often default to nuclear bone/WBC scans, which are more expensive. Why? MRI time is rationed, but nuclear studies are easier to get because they can be billed by clinics.

andyszavakovats.bsky.social•9 days ago

⚖️The result? Overuse of insured tests, underuse of better ones with access barriers, & higher overall costs. It’s not that doctors don’t follow evidence—it’s that policy incentives shape availability, and availability shapes ordering habits.

andyszavakovats.bsky.social•9 days ago

If we want a smarter, greener, & more cost-effective healthcare system, we need to align reimbursement models with evidence-based practice. More CTCA & MRI where it makes sense, less reliance on expensive nuclear studies just because they’re easier to access. 🌱 💰

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