Radiology – not quite sugar or rice

Navigating that bit of commoditization

Last week while driving to Botanic Gardens, a blinking orange light appeared on the dashboard of my Audi. Knowing nothing about cars, I brought it to the designated service centre. They would call me later with the diagnosis. In the evening, the mechanic told me of the problem and explained that a few parts need replacing. This would cost over $1200 and take 3 days to get done. I decided to take my car to a regular service garage the next day. They had me wait 30 minutes and I received a digital report and estimate cost of not more than $600.

Soon after that, I realised a similarity of this scenario as with radiology. Patient care may be obscure to lay people afterall, as how automobile mechanics is to consumers. Putting myself in the patient’s shoes, I thought, will one prefer to receive clear-cut services with a defined quality at a fixed price? I then stumbled upon Quantum’s many chatbot enquiries to find that the questions people ask are quite telling and looks like I found an answer – yes.

It is perplexing that radiology, an essential component of health care, where lives are involved, is somehow treated as a commodity in current times.

Wikipedia defines “commodity” as an economic good or service that has full or substantial inter-changeability: that is, the market treats instances of the good as equivalent or nearly so with no regard to who produced them. Most commodities are raw materials, basic resources, agricultural, or mining products, such as iron ore, sugar, oil or grains like rice.

Radiology is not just the matter of acquiring pictures like a factory’s production line. It is a medical specialty that uses medical imaging techniques like MRI, CT, ultrasound and X-ray to diagnose, follow-up and treat diseases. Apart from expertise, it requires integration of 4 interlinked components of practice – i) pre-examination evaluation for necessity and appropriateness ii) monitoring of scan quality through co-ordination with radiographers about technique and protocols iii) interpretation of the scan and writing a report and iv) post-examination discussion with the referring clinician where necessary. The integration of these 4 components requires cognition. And dissociation of these 4 integrated components produces a commodity.

Radiology requires integration of 4 interlinked components (blue circles). Dissociation of any one of these components result in radiology being a commodity.

The hard truth is, commoditisation has seeped into radiology. In business, it is known that companies that sell commodities typically must offer low prices and deal with slim margins. Because the customers’ perception of the product or service is one of ambivalence. In the customers’ mind, the product or service is just like everyone else’s, so there is no reason to pay more for it. Whether it is car brakes, sugar or white rice, customers believe what they get from one company is identical to what they can get from another.

People need to understand the difference between buying commodities and radiology services, the latter entails a set of metrics and variations rather than a single entity. It is not so simple, it is not one price fits all. Where and how the scan was done, on what machine, using which protocol and why, if the radiologists’ report added value in terms of interpretation, suggestions and management of the patient – these are all important denominators for clinicians and patients to consider.

References:
  1. Forman et al. Masters of Radiology Panel Discussion: The Commoditization of Radiology. AJR2011; 196:843-847
  2. Borgstede JP. Radiology: Commodity or Specialty. Radiology 2008; 247: 613-616
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