INTRODUCING AN INTEGRATED IMAGING DELIVERY SYSTEM IN MANITOBA

Objective: As a result of the reform of a comprehensive government hea lth plan, an integrated imaging system is being created in the provinc e of Manitoba. The intent of the system is to reduce costs, avoid caus ing harm to patients, enhance physician referral services and add new programs. Methods: Evaluation of trends in examinations, equipment, pe rsonnel, expenditures and policy in the 1992-93 and 1995-96 fiscal yea rs in Manitoba. Results: The population has remained steady, at 1.1 mi llion. Hospitals have been amalgamated under new authorities, and Mani toba's annual health care spending of $1.8 billion has been reduced by $235 million. Between the 2 years, use of radiography declined from 8 35 748 to 726 394 examinations per year. Use of mammography, ultrasono graphy, computed tomography, magnetic resonance imaging and nuclear me dicine increased moderately. The total number of radiologic examinatio ns declined from 1 069 579 to 975 044. There was little change in equi pment, but the plant aged as a result of freezes on construction and c apital spending. Personnel declined by 20 full-time equivalent positio ns, from 794.3 in 1992-93 to 774.3 in 1995-96. Savings in operations w ere made as a result of hospital budget restrictions. Total expenditur es declined from $100 million to $89 million. The income of imaging sp ecialists did not change because they were paid higher fees for examin ations involving newer technology. Conclusion: Integration of rural/no rthern and urban hospital services has followed the plan set out in re cent legislation. Savings of up to 20% are expected to be realized thr ough reduction in personnel (saving $1 millionj, group tendering ($1 m illion), inhouse repair ($1 million), reduction in deployment of equip ment ($3 million), integration of services ($1 million), indirect cost reduction ($5 million), practice guidelines ($3.5 million), reduced b reast screening costs ($1 million), physician payment reform ($1 milli on) and rigorous clinical/fiscal audit ($1 million).