Backgrounders
	Diagnostic and Medical Equipment Fund

Information

March 2003

Diagnostic/Medical Equipment Fund Operating Principles

Enhancing the availability of publicly-funded diagnostic care and treatment services is critical to reducing waiting times and ensuring the quality of our health care system. First Ministers agreed to make significant new investments, including support for specialized staff training and equipment, which improve access to publicly funded diagnostic services.

Based on the needs of their health systems and past allocation practices, the capacity of diagnostic and medical equipment varies across jurisdictions. While governments agree that the principal objective of the fund is to improve access to, and quality of, equipment, its use must allow flexibility to address their differing needs.

Publicly funded diagnostic care and treatment equipment includes:

• acquisition of new equipment with established safety, efficacy and effectiveness
• replacement/updating of existing equipment
• direct installation costs of equipment

Jurisdictions have the flexibility to invest, in no particular priority, within the following categories, while recognizing the priorities of Canadians, to improve access to diagnostic and treatment services. Jurisdictions continue to commit to evidence based allocation decisions, and collaborate to improve access.

• Diagnostic imaging equipment
  e.g. MRIs, CT scanners, nuclear medicine equipment, mammography, ultrasound, x-ray/fluoroscope
• Other diagnostic and therapeutic equipment
  e.g. linear accelerators, bone densitometry, echocardiography, major laboratory equipment, Picture Archiving Communication Systems (PACS)]
• Medical/surgical equipment
  Surgical, e.g. lithotripters, laparoscope, surgical laser, anaesthetic gas machines, sterilizers
  Life Support, e.g. dialysis, defibrillators, external pacemakers, ventilators
  Vital signs, e.g. blood pressure & oxygen meter, pumps, monitors
• Patient comfort/safety equipment
  e.g. patient/bed lifts, mobility equipment, patient bathing equipment

The Fund is intended to support increased access to medical and diagnostic equipment. To that end, when a shortage in trained professionals is limiting the use of that equipment, additional investments in training may also be required to increase access. Appropriate training costs, in no particular priority, could include tuition fees; bursaries; equipment specific training; clinical training; or other related costs.

• Extending roles of existing practitioners ¹ by upgrading discipline specific skills
  e.g. MRI; CT scans; radiation therapy; nuclear medicine; delegated routine tests with long waiting lists.
• Cross-training in basics of 2 or more technologies for existing practitioners
  e.g. radiological/nuclear medicine, x-ray/sonographer, radiation/laboratory. This approach is particularly applicable to rural or remote settings.
• Upgrading skills of internationally trained providers, who are in Canada, to address known practitioner shortages.
• Increasing seats in entry-to-practice programs to produce new practitioners to address known shortages.

The Diagnostic/Medical Equipment Fund is not intended to support:

• operating costs for diagnostic care and treatment equipment
• equipment/training eligible under other federal funding initiatives
• costs of equipment used for privately funded diagnostic care and treatment services
• investigational devices ²
• non-clinical/non-patient care equipment

Reporting Provisions
First Ministers agreed, in the 2003 Accord, to report to their citizens on an annual basis on enhancements to diagnostic and medical equipment and services, using comparable indicators, and to develop the necessary data infrastructure for these reports. This reporting will inform Canadians on progress achieved and key outcomes. It will also inform Canadians on current programs and expenditures, providing a baseline against which new investments can be tracked, as well as on service levels and outcomes.

Ministers were directed to consider the following examples, in developing indicators for the Accord on Health Care Renewal by September 2003:

• wait times for radiation therapy for breast and prostate cancer (FMM 2000)
• volume flow/wait times for diagnostic tests (MRI, CT)
• proportion of services/facilities linked to a centralized (provincial/regional) wait list management system for selected cancers and surgeries and diagnostic tests
• number and types of equipment installed
• number of diagnostic professionals to operate equipment

In addition to the reporting provisions contained in the Accord, provinces and territories are encouraged to acknowledge the contribution of the federal Diagnostic/Medical Equipment Fund in public announcements.

1. Practitioner is defined as a licensed health care worker actively providing safe, competent diagnostic testing services and/or treatments associated with imaging/radiation/laboratory medicine equipment.
2. An investigational device is one for which an authorization for importation and sale has been issued under Part 3 (Investigational Provisions of the Medical Devices Regulations). This is a device which has satisfied the safety requirements of the Regulations, but for which the effectiveness data and quality manufacturing requirements of the Regulations have not been satisfied.