Concern over colonoscopy cutbacks

About 80% of people who would once have qualified for free bowel cancer screening colonoscopies through Dunedin Hospital may not be having them now because they have to pay for them, Mercy Hospital chief executive Michael Woodhouse says.

Clinicians working at the private hospital had advised him that while there had been some growth in demand for colonoscopy services since the rules were changed by the Otago District Health Board last October, they were more concerned about the larger group of people who, while they qualified for screening under national guidelines, were not receiving it.

The board reports, however, that patients with possible symptoms of bowel cancer are being seen more quickly at Dunedin Hospital following the introduction of the changes.

A colonoscopy at the private hospital costs about $1000 ( $610 for the hospital fee and $420 for the consultant).

If in the course of the internal examination of the large bowel, a polyp or polyps have to be removed then the fee is greater ( $750 for the hospital and $450 to $550 for the consultant).

Mr Woodhouse said if the move by the health board to charge private patients for laboratory tests goes ahead then some patients could possibly pay hundreds of extra dollars to have polyps analysed in the laboratory.

Each polyp would involve a histology charge and if a patient had many polyps, he expected that would be expensive.

Since there was only one laboratory operating in the South, people would have no choice about the cost.

Mr Woodhouse said if people took risks with their health and later got sick because they could not afford to seek treatment outside the public system it could cost more in the long run.

From October last year, free colonoscopies for people with a close family member who has had bowel cancer have not been routinely available at Dunedin Hospital because of lack of staff, funding and the increased demand from people with possible symptoms of the disease.

Only those people classed as having a genuine hereditary syndrome qualify under the new rules at the hospital.

The hospital is one of at least three in the country which are not able to offer screening in accordance with the national guidelines for surveillance and management of groups at increased risk of colorectal cancer.

Senior lecturer in medicine and consultant gastroenterologist at Dunedin Hospital, Dr Martin Schlup, in a written response to questions from the Otago Daily Times recently, said since the change to routine screening had been made, 62 referrals had been made to the department.

Of the 41 patients who returned the family history questionnaire, 27 met the guidelines and 14 did not.

During that time, a further 28 patients who had previously received surveillance colonoscopies on the basis of family history were advised they would no longer be offered the free service and would be advised that private screening was available.

He did not know how many had sought private colonoscopies.

There had been a few patients who expressed dissatisfaction, but generally acceptance seemed to be high, "which in a way is a reflection on how the health system is conceived by people".

At the time the hospital introduced the changes, some people with possible symptoms were waiting up to six months for a colonoscopy.

Now, the waiting time for a routine colonoscopy would be between four and eight weeks, Dr Schlup said.

All urgent colonoscopies could be carried out within one or two weeks.


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