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Health Services in Australia

Prevention and screening of cervical cancer

What are public health services?

  • The organized response by society to protect and promote health, and to prevent illness, injury and disability
  • The starting point for identifying public health issues, problems and priorities, and for designing and implementing interventions, is the population as a whole, or population sub-groups (NPHP 1997).

Cancer Screening programs

  • The Australian government has undertaken several cancer screening programs for the detection of cervical, breast and bowel cancer.
  • Main objective of these programs is to lower illness and death rates from cancer.
  • By providing early detection and effective follow up treatment.
  • The National Cervical Screening Program makes use of Pap smears for testing.
  • These services are mostly free or usually are covered by a Medicare rebate.

National Cervical Screening Program

  • The program was initiated in the year 1991.
  • It aims at women between the age group of 20- 69 years.
  • Highest participation seen in women between the age group of 55-59 years.
  • Lowest participation seen in the age group of 20-24 years.
  • Women hailing from remote location had lower participation rates.
Contd..
  • The program is a combined initiative of the Australian government along with the state and territory government,
  • The programs main objective is to lower the occurrence of cervical cancer and deaths from it by identification of pre-cancerous lesions.
  • It makes use of a PAP test for screening for abnormalities.
  • The program is a part of the main health services of Australia .
  • Claim for these tests can be made through Medicare.
Reduction in occurrence
  • Ever since the program started the occurrence of cervical cancer has become half.
  • Its recommended women between the age group of 18-68 years of age , who are sexually active test for cervical cancer.
  • 80% cervical cancer occurs in women who have not undergone a screening.
Pap Screen Changes Take Health Equity Backwards
  • Changes will have an impact on women that stay in Australia and will lead to an increment in health inequity.
  • In 2013 only 58% of the women between the ages of 20-69 tested for Cervical cancer.
  • Rates in Melbourne were as low as 44%.
  • If there is an increment in the prices of these screening tests more women will choose not to take the test.
The cost-effectiveness of cervical screening in Australia
  • Strategies were developed by making use of a decision model.
  • The model made use of the Markov Model along with decision trees.
  • The model indicated that rather than having screenings take place twice in a year it was better to conduct them annually and would lead to a increase in the savings of the government funds.
  • Annual screenings can save more lives however it is not cost effective in nature.
Incidences in Australia
  • Lowest mortality rate in the world
  • Second lowest rate for the occurrence of cervical cancer.
  • Success is due to government initiatives for conducting regular screenings at reasonable costs.>
Why is cervical screening changing?
  • As per changes in technology the program will be undergoing several changes.
  • The main purpose of this change is to further enhance early detection facilities so that more lives can be saved.
  • Better treatment options available.
  • Change to be implemented from 1st December, 2017.
Change in technology
  • New test can detect the occurrence of Human Papillomavirus or the HPV infection.
  • Sample collection procedure will remain the same.
  • Current test only detects abnormal changes in the cells that take place before occurrence of cancer.
  • Persistent HPV infection causes changes in the cell that can cause Cervical cancer.
Comparison of the current national cervical screening program with that commencing from December 2017 Current recommendations
  • Pap screening test
  • Test takes place every two years.
  • Between ages of 18-20 years.
From December 2017>
  • >HPV detection test
  • Every five years
  • 25 years onwards
Implementation Strategy
  • Invitations
  • Reminders
  • Educational programs>
  • Counseling of women in schools and educational institutions.
  • Economic interventions.
Evaluating the way forward
  • A review was conducted by the Government’s Medical Services Advisory Committee.
  • Found that the changes in the screening program will lead to saving more lives.
  • Provide easy access to preventive measures and treatment options.
  • Lead to a 20% reduction in incidence and mortality in comparison to the current program.
Primary health-care services for Aboriginal and Torres Strait Islander people
  • The aboriginals have access to primary services while main health services may not be always be accessible.
  • Poor health status of the aboriginals due to lack of access to services.
  • The Australian Government provide funds for providing health care services to the aboriginals.
Emerging models of care
  • Development of nurse led clinics is being undertaken.
  • Day surgical procedures are being performed in the consultants rooms.
  • E health records are being maintained to ensure easy access to patient information.
  • Tele health services for those who are located in remote locations.
Conclusion
  • The National Cervical Screening Program that will be implemented from December 2017 will bring about reforms.
  • It will help in saving more lives and providing better treatment options.
  • Expenditure on health services is rapidly rising due to the ageing population.
References
  • gov.au. (2017).Australia's health system (AIHW). [online] Available at: http://www.aihw.gov.au/australias-health/2014/health-system/ [Accessed 25 Aug. 2017].
  • Aminisani, N., Armstrong, B., Egger, S. and Canfell, K. (2012). Impact of organised cervical screening on cervical cancer incidence and mortality in migrant women in Australia. BMC Cancer, 12(1).
  • Australia, C. (2017). [online] Cancer.org.au. Available at: http://www.cancer.org.au/about-cancer/early-detection/screening-programs/cervical-cancer-screening.html [Accessed 25 Aug. 2017].
  • gov.au. (2017).Cancer Screening - Future changes to cervical screening. [online] Available at: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/content/future-changes-cervical [Accessed 25 Aug. 2017].
  • Ezza, A. and Raspitzu, I. (2017). ALLIANCES IN HEALTHCARE: A QUEST FOR EFFICIENCY AND EQUITY - A CASE STUDY FROM THE ITALIAN HEALTHCARE SECTOR. Review of Business Research, 17(2), pp.25-34.
  • Saville, A. (2015). Cervical cancer prevention in Australia: Planning for the future. Cancer Cytopathology, 124(4), pp.235-240.
  • Smith, M. and Canfell, K. (2016). Impact of the Australian National Cervical Screening Program in women of different ages. The Medical Journal of Australia, 205(8), pp.359-364.
  • Vella, A. (2017). Pap screen changes take health equity backwards. [online] Womens Health West. Available at: http://whwest.org.au/6474-2/ [Accessed 25 Aug. 2017].
  • int. (2017). WHO | Cervical cancer prevention and the Millennium Development Goals. [online] Available at: http://www.who.int/bulletin/volumes/86/6/07-050450/en/ [Accessed 25 Aug. 2017].
  • Whop, L., Cunningham, J. and Condon, J. (2014). How well is the National Cervical Screening Program performing for Indigenous Australian women? Why we don't really know, and what we can and should do about it. European Journal of Cancer Care, 23(6), pp.716-720.
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