A Patient Perspective of Diagnostic Imaging: The Right to Access

Diagnostic imaging has changed the face of medicine in the field of diagnosis and treatment. What began with the humble X-Ray has expanded to include modalities such as Ultrasound, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and most recently nuclear medicine examinations such as the Positron Emission Tomography (PET) scan. Millions of Australian patients access diagnostic imaging services each year for a whole myriad conditions, ranging from a broken bone to cancer diagnosis and treatment monitoring. It is therefore no surprise that diagnostic imaging is at the forefront of early diagnosis and early treatment of many conditions which if left undetected would not be treatable.
However, despite the overwhelming benefits of diagnostic imaging, the current Medicare arrangements are undermining access to quality diagnostic imaging services, putting the health of many Australians at risk. For example, the diagnostic imaging rebates under Medicare have not been indexed since 1998. This has resulted in the systematic increase in patient gaps which averaged $92.00 per service in 2013-14 and have grown by 6.6% each year. Patients are having to choose between adequate care and foregoing necessary diagnostic imaging services due to the prohibitive costs.
In response to these growing pressures, ADIA launched the HELP Campaign in 2013 to gain an insight into the patient perspective on the accessibility and affordability of diagnostic imaging services throughout Australia. This has helped us to determine what needs to be done to ensure affordable and accessible diagnostic imaging for all Australians.

About the campaign

ADIA’s 2013 HELP Campaign educated patients on issues affecting the accessibility and affordability of diagnostic imaging for patients, such as the freeze on indexation, and asked patients questions to gain a perspective on the difficulties patients face when accessing diagnostic imaging services. It also enabled respondents to offer an insight into the value of diagnostic imaging to their daily lives.
Pamphlets were distributed to over 400 diagnostic imaging practices nationwide, with the bulk of responses coming from New South Wales, Queensland and Victoria (see figure 1).
 
With around 1000 responses, ADIA collated information about the utility of diagnostic imaging from the patient perspective, including the importance of diagnostic imaging for patients and the challenges patients face when accessing services.
 
 
‘Without my MRI I would have died thinking I had a sinus infection’ - Peter
 

Importance of Diagnostic Imaging

The Utility of Diagnostic Imaging

Regardless of a person’s age or personal circumstances, the importance of diagnostic imaging in the diagnosis and treatment of conditions is unparalleled. Respondents identified themselves as coming from all walks of life, including: children, students, single parent/single income families, pensioners and self-funded retirees.
Diagnostic imaging offers a variety of modalities that assist patients from all walks of life. Ultrasound, for example, can be used to follow up on the stability or growth of cancers in the abdomen and it is also used in paediatrics to detect hip dysplasia in newborns. Similarly, the use of X-Rays, while generally associated with identifying fractures, it is also essential in the diagnosis and monitoring of a wide range of conditions including arthritis, pneumonia, lung cancer and heart failure. These are just two modalities that highlight the universal utility of diagnostic imaging for all patients. Other modalities such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), Bone Densitometry (BMD), Mammography and Nuclear Medicine widen the scope of diagnostic medicine considerably, giving patients access to imaging that will provide the best chance of diagnosis and treatment. Without access to diagnostic imaging patients miss out on early diagnosis and proper treatment which puts them at significant risk.
Given the wide scope of diagnostic imaging, it is no surprise that it deals with a vast array of conditions. Figure 2 outlines the top ten conditions respondents identified as their reason for requiring diagnostic imaging services:

 
*Based on the conditions selected by respondents for the 2013 HELP Campaign. Please note: respondents with multiple conditions have had each condition included separately. Source: ADIA.
 
It is important to note that there are a myriad of other common conditions that require diagnostic imaging services, such as:

• Alzheimer’s Disease


• Multiple Sclerosis


• Epilepsy


• Kidney Disease


• Stroke


• Deep Vein Thrombosis


• Parkinson’s Disease


• Hearing loss


• Vertigo

This is by no means an exhaustive list and the utility of diagnostic imaging for numerous conditions is increasing as technology advances.

The need for Diagnostic Imaging

Most of us at one time or another will require diagnostic imaging services, whether it be an X-Ray for a broken bone or an Ultrasound during pregnancy. It is also quite common for patients to require on-going diagnostic imaging services. Patients that are diagnosed with cancer, for instance, require diagnostic imaging services not only for diagnosis and treatment but for on-going monitoring once in remission. Regular access to diagnostic imaging services is also required for those patients suffering from multiple conditions. For example, over 60 % of respondents stated that they suffered from at least two conditions that required diagnostic imaging services (see Figure 3).

 
*Based on the conditions selected by respondents for the 2013 HELP Campaign. Source: ADIA.
 
 
 
Diagnostic imaging is a powerful tool in the patient journey, whether it be for an isolated incident or ongoing care. However, despite the substantial benefits of diagnostic imaging in the prevention and treatment of numerous conditions, patients face a number of significant barriers when attempting to access these services.
This is Part One of a Two-Part series by Pattie Beerens, CEO of the Australian Diagnostic Imaging Association.