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Bowel Cancer Screening Program - Follow up

Country: 
Australien
Partner Institute: 
Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney
Survey no: 
(11)2008
Author(s): 
Marion Haas
Health Policy Issues: 
Prävention, Organisation/Integration des Systems, Zugang
Reform formerly reported in: 
Bowel Cancer Screening Program
Bowel Cancer Screening Pilot
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein nein nein ja nein

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.

Neue Entwicklungen

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.

 Suchhilfe

Characteristics of this policy

Innovationsgrad traditionell traditionell innovativ
Kontroversität unumstritten unumstritten kontrovers
Strukturelle Wirkung marginal marginal fundamental
Medienpräsenz sehr gering gering sehr hoch
Übertragbarkeit sehr systemabhängig recht systemneutral systemneutral
current current   previous previous

No change from previous report.

Purpose and process analysis

Current Process Stages

Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein nein nein ja nein

Initiators of idea/main actors

  • Regierung: 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.
  • Wissenschaft: 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
Regierung
Governmentsehr unterstützendunterstützend stark dagegen
Wissenschaft
scientific communitysehr unterstützendsehr unterstützend stark dagegen
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

Regierung
Governmentsehr großsehr groß kein
Wissenschaft
scientific communitysehr großgroß kein
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

Qualität kaum Einfluss neutral starker Einfluss
Gerechtigkeit System weniger gerecht two System gerechter
Kosteneffizienz sehr gering neutral sehr hoch
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: Umsetzung, Strategiepapier, Gesetzgebung
Bowel Cancer Screening Pilot
Process Stages: Evaluation, Idee, Pilotprojekt

Author/s and/or contributors to this survey

Marion Haas

Empfohlene Zitierweise für diesen Online-Artikel:

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