Value for money: putting the patient first.

Canadians spend more on healthcare than people in most other countries. We are fifth in the OECD in terms of health spending per capita, and eighth out of 28 countries in terms of health spending as a percentage of GDP. Given these facts, it is appropriate to discuss the issue of value for money in healthcare. In their paper, McGrail et al. present four challenges to improving value for money in Canadian healthcare: a lack of analysis of the hospital sector; the need to learn from rate variation analysis; the slow uptake of the electronic health record (EHR); and the need to measure health outcomes. Our paper addresses each of these points, but also proposes that a broader outlook is needed to come to grips with this question. It is essential to go beyond supply-side cost control, and also take into account the needs of the patient. Moreover, we need to look beyond our borders to learn how other countries have been able to evolve universal publicly funded health systems without long waiting times.

Coronary computed tomography angiography: overview of technical aspects, current concepts, and perspectives.

Multidetector-row electrocardiogram (ECG)-gated cardiac computed tomography (CT) will probably be a major noninvasive imaging option in the near future. Recent developments indicate that this new technology is improving rapidly. This article presents an overview of the current concepts, perspectives, and technical capabilities in coronary CT angiography (CTA). We have reviewed the recent literature on the different applications of this technology; of particular note are the many studies that have demonstrated the high negative predictive value (NPV) of coronary CTA, when performed under optimal conditions, for significant stenoses in native coronary arteries. This new technology's level of performance allows it to be used to evaluate the presence of calcified plaques, coronary bypass graft patency, and the origin and course of congenital coronary anomalies. Despite a high NPV, the robustness of the technology is limited by arrhythmias, the requirement of low heart rates, and calcium-related artifacts. Some improvements are needed in the imaging of coronary stents, especially the smaller stents, and in the detection and characterization of noncalcified plaques. Further studies are needed to more precisely determine the role of CTA in various symptomatic and asymptomatic patient groups. Clinical testing of 64-slice scanners has recently begun. As the technology improves, so does the spatial and temporal resolution. To date, this is being achieved through the development of systems with an increased number of detectors and shorter gantry rotation time, as well as the development of systems equipped with 2 X-ray tubes and the eventual development of flat-panel technology. Thus further improvement of image quality is expected.