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Bowel Cancer Screening Program - Follow up

Country: 
Australia
Partner Institute: 
Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney
Survey no: 
(11)2008
Author(s): 
Haas, Marion
Health Policy Issues: 
Prevention, System Organisation/ Integration, Access
Reform formerly reported in: 
Bowel Cancer Screening Program
Bowel Cancer Screening Pilot
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no no yes no

Abstract

In 2005/06 the Australian government committed AU$43 million to a national screening program for bowel cancer. The target population is individuals turning 55 or 65 years of age plus those previously involved in the pilot program. While funds have been allocated for recruitment and the initial screening test, including the formation of a register, no specific additional funds have been allocated for the follow-up health care required by those who are identified as having a positive screen.

Recent developments

The results of the pilot program were predicated on a number of important issues:

1) that the target population would be individuals aged 55-75;

2) that attention should be given to providing Aboriginal people with greater access and information; and

3) that there would be sufficient capacity to provide the additional health services needed by those whose screening test was positive.

However, the policy as implemented is somewhat different: 1) the target population is individuals turning 55 or 65; 2) the target population for Aboriginal people is individuals aged 45 - 75; and 3) no additional funds were provided for the management of positive screening tests etc. Meanwhile a new government has been elected and it is unclear whether the existing program will be modified, continued unchanged or a different program implemented.

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Characteristics of this policy

Degree of Innovation traditional traditional innovative
Degree of Controversy consensual consensual highly controversial
Structural or Systemic Impact marginal marginal fundamental
Public Visibility very low low very high
Transferability strongly system-dependent rather system-neutral system-neutral
current current   previous previous

No change from previous report.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no no yes no

Initiators of idea/main actors

  • Government: The new Labor government has not released plans for the Bowel Cancer Screening program. It has stated that it is committed to screening for those aged 50+ but has provided no details.
  • Scientific Community: The scientific community is concerned that there will not be sufficient capacity in the system to deal with the number of colonoscopies required as a follow-up to positive screening tests.

Stakeholder positions

The new national government is focusing on two broad issues in relation to health: the re-negotiation of the Commonwealth-State healthcare agreements and the forthcoming budget. Therefore, most government announcements address issues such as reducing inefficiencies caused by the two levels of government and the problems of inflation and interest rates, rather than on specific issues such as funding for a particular program.

During the election campaign, the Labor party committed to finding a bowel screening program for those aged 50 and over. No further policy directions have been announced. However, in the light of both the negotiations around the agreement and the budget deliberations, those involved in implementing and evaluating the program are beginning to lobby the Minister about ongoing funding for the screening program as well as for the increase in colonoscopies expected as a result of screening. In particular, the scientists are concerned that if decisions are delayed until an agreement between the Commonwealth and States is reached or until the budget, it will be too late for many aspects of the program to be rolled out.

Actors and positions

Description of actors and their positions
Government
Governmentvery supportivesupportive strongly opposed
Scientific Community
scientific communityvery supportivevery supportive strongly opposed
current current   previous previous

Influences in policy making and legislation

n/a

Legislative outcome

n/a

Actors and influence

Description of actors and their influence

Government
Governmentvery strongvery strong none
Scientific Community
scientific communityvery strongstrong none
current current   previous previous
scientific communityGovernment

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

Those most directly affected are the individuals requiring follow-up colonoscopies. It has been estimated that the 200,000 people who have taken the screening test have created extra demand for 14,000 follow-up colonoscopies to check for cancer or pre-cancerous polyps. The extent to which these individuals have to wait depends on the capacity of the health system in the State in which they live ie whether there is a waiting list for colonoscopies.

Monitoring and evaluation

The recommendations of the evaluation of the pilot program were modified for the implementation of the screening program (as detailed above). The previous report for this survey identified the down strema issues of ensuring the availability of high-quality colonoscopy services as an important issue. No evaluation of the current program is yet available.

Expected outcome

Modification of the target population may have lowered participation rates compared with the pilot program. Any further changes (eg by changing the age to 50+) would potentially confuse participants. If the issues around the availability of follow-up are not resolved, both health outcomes and trust in the program may be undermined.

Impact of this policy

Quality of Health Care Services marginal neutral fundamental
Level of Equity system less equitable two system more equitable
Cost Efficiency very low neutral very high
current current   previous previous

The main impact of lack of colonoscopy services is likely to be on equity. However, there may be a real or perceived impact on health outcomes if individuals cannot access follow-up services relatively quickly when their health is a concern.

References

Sources of Information

Australian Government: Cancerscreening. www.cancerscreening.gov.au 

"Colonoscopy queue swamps state hospitals". The Australian. March 1, 2008

Kees van Gool. "Bowel Cancer Screening Program". Health Policy Monitor, April 2006. Available at www.hpm.org/survey/au/a7/2

Reform formerly reported in

Bowel Cancer Screening Program
Process Stages: Implementation, Policy Paper, Legislation
Bowel Cancer Screening Pilot
Process Stages: Evaluation, Idea, Pilot

Author/s and/or contributors to this survey

Haas, Marion

Suggested citation for this online article

Haas, Marion. "Bowel Cancer Screening Program - Follow up". Health Policy Monitor, April 2008. Available at http://www.hpm.org/survey/au/a11/5