OHIP AST reimbursement limits tied to lower liver fibrosis screening in diabetes

A new Ontario study of more than 1.6 million adults with diabetes found that reimbursement restrictions for a routine blood test were linked to fewer liver fibrosis screenings after 2013. The findings raise questions about whether coverage policy is making it harder to spot liver disease early in high-risk patients.

Why it matters: - Ontario’s reimbursement policy may have reduced access to early liver fibrosis screening for adults with diabetes. - The drop matters because metabolic dysfunction-associated steatotic liver disease, or MASLD, affects about one in three adults globally and is common in people with type 2 diabetes. - Delayed detection can leave patients undiagnosed until they develop advanced fibrosis, cirrhosis, liver failure or liver cancer. - The findings come as healthcare systems expand screening pathways and prepare for new treatments for metabolic dysfunction-associated steatohepatitis, or MASH.

What happened: - Researchers analyzed healthcare data from more than 1.6 million adults with diabetes in Ontario. - The study examined how a 2013 Ontario Health Insurance Plan, or OHIP, reimbursement restriction for aspartate aminotransferase, or AST, testing affected liver fibrosis screening from 2010 to 2022. - The study was published in Scientific Reports, a Nature Portfolio journal, as an open-access paper. - The paper is titled "Reimbursement restrictions reduce liver fibrosis screening in adults with diabetes in Ontario: a population-based interrupted time series analysis." Full study DOI

The details: - AST is one of the lab tests needed to calculate the Fibrosis-4, or FIB-4, index. - FIB-4 is a simple and inexpensive tool used in primary care to identify people at risk for advanced liver fibrosis. - Researchers found liver fibrosis screening declined after the reimbursement restriction took effect. - The study suggests the policy may have created a barrier to identifying people at high risk for advanced liver disease. - Diabetes Canada released the first Canadian clinical practice guidelines to include advanced fibrosis screening with FIB-4 for people with type 2 diabetes last year. - The Fatty Liver Alliance said the result shows evidence-based screening depends on both clinical guidelines and supportive reimbursement policy.

Between the lines: - The study points to a mismatch between clinical guidance and insurance coverage. - Reimbursement decisions can shape who gets tested, when they get tested and whether routine screening reaches the patients who need it most. - The authors say the Ontario findings likely have implications beyond the province as other systems adopt liver fibrosis screening pathways. - The research adds policy context at a time when health systems are trying to balance cost control with earlier detection of chronic liver disease.

What's next: - The authors hope the findings will inform future policy decisions that support equitable access to evidence-based preventive care. - Reimbursement and coverage rules may need to be reviewed as liver screening expands and MASH treatments become more available. - Health systems adopting FIB-4 screening may need to ensure that lab access is not undermined by payment restrictions.

The bottom line: - The Ontario study suggests reimbursement policy can either support or slow down early liver disease detection in people with diabetes.