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Management control of open-access radiology: is it possible?
Insights
Restricting general practitioner access to radiology services is not advised due to lack of evidence. Re-evaluating the radiologist's role in managing service appropriateness is the best option for optimizing diagnostic imaging.
Area of Science:
- Healthcare Management
- Radiology Services
- Diagnostic Imaging
Background:
- Increasing demand for open access radiology services challenges current capacity.
- Cost containment pressures make restricting general practitioner access to radiology appealing to managers.
- Blanket restrictions on radiology access lack economic or clinical justification.
Purpose of the Study:
- To evaluate management strategies for controlling general practitioner utilization of open access radiology.
- To determine the feasibility and effectiveness of restricting access to diagnostic imaging services.
- To propose optimal management approaches for radiology services.
Main Methods:
- Analysis of management options for controlling general practitioner referrals to radiology.
- Assessment of the practicality of explicit quota systems for radiology access.
- Examination of incentive and cost manipulation in balancing clinician and manager objectives.
Main Results:
- Explicit quota systems for radiology referrals are deemed infeasible.
- Blanket restrictions on radiology access are not economically or clinically sensible.
- Re-evaluating the radiologist's role in service management is identified as the most effective strategy.
Conclusions:
- Management should focus on the radiologist's role in assessing referral appropriateness using guidelines.
- Implicit manipulation of incentives and costs requires closer examination by managers.
- Optimizing radiology service management involves a radiologist-led approach to appropriateness of care.
Abstract:
This paper considers management options for limiting general practitioner use of open access radiology - a service for which there is increasing demand which is difficult to meet. In the current climate of cost containment, restriction of general practitioner access to these expensive diagnostic facilities has management appeal. However, it is difficult to justify blanket restriction of access to radiology services as there is no evidence that it would be economically or clinically sensible. An explicit quota system is unlikely to be feasible because of the small number of referrals made by general practitioners and the element of chance which will inevitably enter into the referral process. Managers should examine more closely the manipulation of incentives and costs which are used, often implicitly, to balance the conflicting desires of clinicians and managers. The best management option would appear to involve a re-evaluation of the role of the radiologist to include responsibility for managing the service. This should include assessment of appropriateness of referral by reference to guidelines for investigation and the behaviour of acknowledged good practitioners.