Free radiology imaging screening studies - an idea which undoubtedly stems from multiple desires. At first glance, an altruistic attempt to give everyone a fighting chance to access the same aspect of health care. Upon more reflection, however, free anything reminds us that there is no free lunch. Everything must come with a cost.

The Lahey Hospital in Burlington, MA, has implemented a CT chest screening program where the study is offered free of charge.

Obviously, such an offer is made with the idea that a certain percentage of the screening studies will yield positive findings which then require, or could benefit from, additional radiology imaging studies to either confirm, deny or follow the original findings. The screenings are therefore a loss leader.

Such a program is easily compared to self-referral: Does the ordering physician end up pushing his patients towards more imaging or follow-up procedures in order to make up for the revenue lost by offering free screening studies?

A cost analysis can readily determine whether offering free screening studies results in a sustainable financial situation for the imaging center or hospital.

The bigger question is whether free universal screenings identify positive findings that require follow-up studies/procedures which result in a public health benefit? Or, do they result in numerous unnecessary additional tests and procedures that do not serve any public health purpose but that, instead, further increase health care costs and possibly harm patients?

It is certainly a positive-sounding decision, on its face, to state categorically that free screenings will now be offered for everyone. The devil is always in the details, however.