Ontario’s Convoluted Genetic Test Funding

I had a discussion with a Ministry of Health employee about funding for genetic testing.  I have not yet been able to verify the details through formal Ministry channels, a process which could take years with their penchant to secrecy. Nonetheless, they are in line with the overall government approach to laboratory testing policy and seem likely.  If they are close to the truth, they are important bits of information for an informed public discussion on genetic testing.

First, when the LHINs were instituted in 2005 genetic testing was made a LHINs responsibility Local Health Integration Networks, LHINs, are Ontario’s regional health authorities.  As a consequence funding was frozen within
the public system for these tests. Few new tests were introduced and it became more difficult to access existing tests.  As with community lab work, did this result in increased use of private labs in Ontario for genetic testing at public expense? This is still unknown, but it did increase use of out of country testing, primarily testing in for-profit  American labs.

The use of the LHINs to save money in their budget by restricting testing in public hospitals is the approach they took lab tests ordered by family doctors.  The LHINs effectively closed all public hospitals in Ontario to processing community laboratory tests shifting that work to more expensive for-profit laboratories.

Using private labs in the States is significantly more expensive than performing the same test in a public hospital in Ontario.  In the last couple of years, to decrease the stress on its budget, the section of Ontario’s Ministry of Health responsible for paying for out of province health care has started to pay Ontario hospitals to do these tests.

What a fine example of silos within one ministry and convoluted policy making.  One section of the Ministry of Health is underfunding hospitals to save money forcing another section to increase its costs and ultimately fund the responsibilities of the first section so it can save money.  I am not sure that sentence makes sense, but neither does the policy.

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2 Comments on “Ontario’s Convoluted Genetic Test Funding”

  1. dorfmanr Says:

    I feel your pain! the MOHLTC policy was misguided and was looking only at the short-term impact of costs of “unrestricted” genetic testing without properly evaluating the socio-economic impact on disease management and prevention.
    http://www.health.gov.on.ca/english/public/pub/ministry_reports/geneticsrep02/chepa_rep.pdf


    • Thanks for the link. One point the authors make, when discussing some of the cost considerations on which tests to cover, is:

      “….unlike non-genetic screening, for-profit corporations now hold exclusive patents on many genetic testing technologies. They have incentive to push for broad adoption of such tests and may pursue aggressive marketing practices to advance their economic interests. This may particularly be the case when organizations sell goods and services complementary to the genetic test (a practice already seen for non-genetic tests such as bone-densitometry and serum lipid testing).”

      It is easy to find examples where companies aggressively market these products to the public increasing public pressure for their coverage regardless of their benefit. One example is the introduction to the APOE test on the Matrix Genomics web site which starts off which what amount to scare statement:

      “The e4 form of APOE multiples risks of memory impairment, cognitive decline & Alzheimer’s disease
      One in five women, and one in 10 men, develops Alzheimer’s disease by age 85. It is caused by many factors, both inherited and related to lifestyle. Memory impairment and cognitive decline share risk factors with Alzheimer’s disease.”

      Matrix then offers a test to differentiate the APOE genetic components and ends with a small disclaimer that the test is not a diagnostic tool.


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