National Bowel Cancer Screening Program - Term Paper Example

National Bowel Cancer Screening Program Executive Summary The National Bowel Cancer Screening Program (NBCSP) is an initiative of the Australian Government, with the objective of reducing the prevalence and harsh consequences of bowel cancer. The screening program is monitored and evaluated by the Australian Department of Health and Ageing and implemented by Medicare Australia. The other two key stake holders are Cancer Council Australia and the general practioners. All the key stake holders support the requirement of such a screening program. The divergence in positions is with respect to the coverage of the screening program and the single FOBT used in the screening program. The Australian Department of Health and Ageing and Medicare Australia with strong power and similar positions on these divergent views are able to have their way in the implementation of the program. The National Bowel Cancer Screening Program The National Bowel Cancer Screening Program (NBCSP) is a health action program of the Australian Government that is conducted with the cooperation of all the States and Territory health departments, with the objective of early detection of bowel cancer for reducing the morbidity and mortality rates that are a consequence of the disease (General Practice Queensland, 2009). The relevance of NBCSP lies in the fact that bowel cancer is among the most frequently found cancers in Australia, with a high rate of attrition. Detection in the early stages can alleviate this situation, as early detection results in successful treatment of bowel cancer (Department of Health and Ageing, 2009). NBSCP targets the age group above the age of fifty, and resulted from the success experienced by the pilot screening project in 2005. The first phase of NBSCP commenced in the middle of 2006 and targeted the age group of between 55 and 65 years (Lin, Smith & Fawkes, 2007). The ongoing second phase started in 2008 and will run till the end of 2010, targeting the older Australian population above the age of fifty and the Indigenous Australians above the age of 45 at specific ages. The Australian Government has committed $67.2 million towards this second phase of NBCSP (General Practice Queensland, 2009). Eligible individuals under NBCSP are invited to the program by mail. The screening process involves a simple faecal occult blood test (FOBT) done at home, followed by testing at a competent laboratory facility. Individuals with a positive result, then consult with their GPs, refer them for further investigations to the specialists (Department of Health and Ageing, 2009). The Australian Department of Health and Ageing with its focus on enhancing the health of the older population segment monitors and evaluates NBSCB (Van Gool, 2006). Medicare Australia in essence runs the screeing program starting with the invitations, encouraging the participation of GPs, making payments towards the expenses and maintaining the records of the screening program. The GPs play the functional role of being the first point contact with medical professionals, for those individuals with postive test results (Medicare Australia, 2010). Cancer Australia is the biggest non-governmental organization involved in the prevention, detection and treatment of cancer (Cancer Council Australia, 2010). Thus the Australian Department of Health and Ageing, Medicare, Australia, the general practioners and Cancer Council Australia are four key stake holders in NBCSP. Positions of the Stakeholders The position taken by the Australian Department of Health and Ageing on NBCSP reflects the position of the government. NBSCP is restricted to those turning 50, 55, or 65 between 2008 and 2010, since there is a sharp rise in the potential risk for bowel cancer from the age of 50 onwards. The objective of the Australian Department of Health and Ageing is to make sure screening of the high risk group and thereby reduce the incidence of bowel cancer..Those between ages of 51 to 54 or 56 to 59 are not invited to the screening program and hence do enjoy the benefits of the program. This position leads to inequity in the screening for bowel cancer (Javanparast et al, 2010). Cancer Council Australia has however taken the stand that all Australians between over 50 have to be evsluared for bowel cancer using FOBT once in two years. In the current scenarion maintaing such a screening requirement by individuals means that they will have to pay for the FOBT, since they will not be covered under NBCSP. NBCSP will pay for the FOBT tests between 2008 and 2010 only for those attaining the ages 50, 55 or 65 in this period. The position for repeated testing after the age of 55 by Cancer Council Australia to ensure that the screening tests is more effective for identfying bowel cancer and thereby reduce the consequences of the disease (Cancer Council Australia, 2010). Medicare Australia, which is the implementing body for NBCSP supports the specific limited screening program through NBCSP. It takes this position on the ground that the screening program needs to implemented in a slow manner to allow the supplementary health services required subsequent to the screening to be able to sustain the increased demand for such health services. In other words the implication of the position of Medicare Australia is that the supplementary health services required by the screening program are inadequate and it is thgis reason that prevents meeting the demand of Cancer Council Australia for all individuals above the age of 50 to be incuding in the screening program (Medicare Australia, 2010). The position of the general physicians in Australia essentrially stems from the lomited choice provided to the targeted audience, as only FOBT is the eligible free test for the screening program. This ethical position of the general practioners questions the lack of informed consent and choice to the paerticipants of the screening program. This position of the general physicians stems from the medical ethic of patient autinomy in availing of health services (Salkeid, Young & Solomon, 2006). Influence of the Stake Holders Government policies and programs may have an authoritative ring about it, but in reality the outcone of such policies is decided by those groups of individual, who have a strong say in the matter (Colebatch, 2002). Policies and programs run into havy weather, when the tugs and pulls from the different stake holders are strong enough to disrupt the harmonous functioning of the program (Keleher & Reiger, 2004). In essence this means that for the successful implementation of a policy or program, there is the need for a harmonious rhythm between the policy makers, the program administrators, the program implementers and the stake holders (Althaus, Bridgman & Davis, 2007). The costs of a policy or program is the linmiting factor in extending the benefits of the policy or program. However, by ensuring leaner adniminstrative costs and money paid out for the implementation of the program, it would be possible to increase the number of benificiaries of a policy or program (Gawande,2009). The thread that weaves through all this is that political authorities bring out programs envisaging certain benefits for the population, but the outcome is decided by the administrative authorites, the implementing bodies and the other key stakeholders, based on the amount of influence they possess. The maximum influence is exerted by the stakeholders that retain the maximum power in an activity that makes it necessary for several groups of people to function in harmony (Barnes, 1988). Seen from this perspective, Medicare Australia with its control on the purse strings and the Australian Department of Health and Ageing as the monitoring and evaluation organization exert the maximum influence and through that control the direction and content of the screening program. These two organization in concerted pull have been able to limit the extent of the screening program and the screening test employed to FOBT, which are the bones of contention with Cancer Australia and the General practitioners respectively. The strength of Cancer Council Australia lies in its abiltiy to rouse public opinion towards extending the screening program for all citizens over 50 or in other words greater equity in the program. The strength of its influence is limied due to the large time frame needed for it to demonstrate its strength. The weakest influence is exerted by the general practioners calling for greater patient autonomy through greater choice, as this would vastly increase the cost and convenience of the program. However, the program continues to remain a satisfactory program as there are no key holders opposing the program. Even those with differing views, like Cancer Council Australia and the general practioners support the program and differ only in some aspects of implementation. Conclusion The second phase of the NBCSP started in 2008 and carries on in 2010 with the objective of reducing the incidence and morbodity of bowel cancer. The screening program is montored and evaluated by the Australian Department of Health and Ageing, it is implemented by Medicare Australia. Two other key stake holders are Cancer Council Australia and the general practioners. The Australian Department of Health and Ageing and Medicare Australia subscribe to the view that screening need be carried out as per the program only for those attaining the ages of 50, 55 and 65, so as not to strain the supplementary services required, Cancer Council holds the position that every individual above the age of 50 needs to be screened for bowel cancer and the general practioners are unhappy on the lack of choice that the partcipants have, as only FOBT is permitted under the program. The Australian Department of Health and Ageing and Medicare Australia hold the power in this program and so are able to direct the progrm in the manner they want it. The screening program remains successful, as all the key stake holders support a screening program for bowel cancer. Literary References Althaus, C., Bridgman, P. & Davis, G. (2007). The Australian Polcy Handbook. Fourth Edition. New South Wales: Allen & Unwin. Barnes, B. (1988). The Concept of Power. Oxford: Polity Press. Cancer Council Australia. (2010). About us. Retrieved March 27, 2009, from Web Site: http://www.cancer.org.au/aboutus.htm Cancer Council Australia. (2010). Bowel cancer screening. Retrieved March 27, 2009, from Web Site: http://www.cancer.org.au/cancersmartlifestyle/Earlydetection/Screeningprograms/Bowelcancerscreening.htm Colebatch, H. (2002). Policy. Second Edition. Buckingham, U.K: Open University Press. Department of Health and Ageing. (2009). National Bowel Cancer Screening Program. Retrieved March 27, 2009, from, Australian Government Web Site: http://www.health.gov.au/internet/screening/publishing.nsf/Content/bowel-about Gawande, A. (2009). The Cost Conundrum: What a Texas Town can Teach us about Health Care. New Yorker. Retrieved March 27, 2009, from HTTP://WWW.NEWYORKER.COM/REPORTING/2009/06/01/090601FA_FACT_GAWANDE?CURRENTPAGE=ALL General Practice Queensland. (2009). National Bowel Cancer Screening Program. Retrieved March 27, 2009, from Web Site: http://www.gpqld.com.au/page/Programs/Population_Health/National_Bowel_Cancer_Screening_Program/ Javanparast, S., Ward, P., Young, G., Wilson, C., Carter, S. & Misan, G. (2010). How equitable are colorectal cancer screening programs which include FOBTs? A review of qualitative and quantitative studies. Preventive Medicine, 50(4), 165-172. Keleher, H. & Reiger, K. (2004). Tensions in Childhealth Maternal and Child Health Policy in Victoria: Looking Back and Forward. Australian Health Review, 27(2), 17-26. Lin, V., Smith, J & Fawkes, S. (2007). Public Health Practice in Australia: The organised effort. New South Wales: Allen & Unwin. Medicare Australia. (2010). National Bowel Cancer Screening Program - information for health professionals. Retrieved March 27, 2009, from, Australian Government Web Site: http://www.medicareaustralia.gov.au/provider/patients/nbcsp/index.jsp Salkeid, G. P., Young, J. M. & Solomon, M. J. (2006). Consumer choice and the National Bowel Cancer Screening Program. The Medical Journal of Australia, 184(11), 541-542. Van Gool, K. (2006). Bowel Cancer Screening Program. Health Policy Monitor. Retrieved March 27, 2009, from Web Site: http://www.hpm.org/en/Surveys/CHERE_-_Australia/07/Bowel_Cancer_Screening_Program.html Read More