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You’ll be boweled over by this cheap Budget lifesaver

Paul Grogan

by Paul Grogan

13 Mar 05:45am

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Filed under: Bowel Cancer, Budget 2012, Cancer, Economics, Health, Politics

34 comments

If most of us ran our household budgets like governments run health budgets, we’d be on the streets.

Bowel cancer is Australia's second biggest cancer killer, and an easy one to prevent. Illustration: Michael Perkins

The lack of apparent logic in health funding will be highlighted today by a joint statement from independent MPs Tony Windsor, Rob Oakeshott and Andrew Wilkie, calling on the federal government to expand its National Bowel Cancer Screening Program in the 2012-13 budget.

For the three Independents to make this united plea says two things: they are concerned for the health of the nation and for people in their electorates; and the argument for an urgent expansion of the NBCSP is compelling.

I’ve had direct discussions with the independents on this issue and can personally vouch for the first point. The second point should be just as easy to explain.

Bowel cancer is the nation’s second biggest cancer killer yet one of the easiest to treat if detected early. And it’s one of only three cancers (along with cervical and breast cancers) that can be picked up early with a population screening test that has been shown in multiple studies to save lives on a cost-effective basis.

The NBCSP could prevent up to one third of all bowel cancer deaths among Australians age 50 and over if it was available to them every two years. However, it remains a one-off test only to people turning 50, 55 and 65 – almost six years after being introduced. Millions are missing out on a test that could save their lives. In addition, independent analyses have shown that a full NBCSP is one of the best economic investments in public health available to the government.

Why, then, in a country that is second on the United Nation’s Human Development Index do we need three independent parliamentarians to call for such a no-brainer of a budget initiative?

Welcome to the bizarre world of health economics.

Multiple studies over many years have shown that investing in disease prevention is great value for the taxpayer. The milestone Applied Economics’ analysis, Returns on Investment in Public Health, published by the federal government a decade ago, showed extraordinary returns on a range of key investments.

For example, money put into reducing tobacco consumption from the early 1970s had returned $2 for every $1 spent; programs for reduced cardiovascular disease had yielded $8 for every $1 spent, while measles prevention had led to a massive $155 to $1 return on investment.

The combined returns are like the enviably good fortune of the person you meet at a party who tells you they bought a unit at Bondi 20 years ago for $100,000 and now it’s all paid off and worth $1 million. It’s that simple.

So why do governments only invest around 2 per cent of the health budget into prevention? The answer, it seems, is that they tend to think in the short term – read “election cycle” – at the expense of the community’s longer-term benefit.

The big economic gains from public health investments usually take a decade to accrue. But when they do, they pay off phenomenally. It’s a grand-scale equivalent of the homebuyer who budgeted to chip away at their mortgage 20 years ago and is now a millionaire. The main difference is that the smart homebuyer isn’t worried about short-term political popularity. If they were, instead of paying the mortgage they might splurge continually on costly partying. Fun for a while, but few of us who seek long-term financial security can live this way.

What’s even more frustrating and tragic about the NBCSP is that its limited reach means there are people walking around in good health, right now, with a fatal bowel cancer that will kill them because they did not have access to the program. So it’s about saving lives now as well as ROI.

We need people to urge the government to run public health the way most of us manage our long-term personal finances. All it requires is some patience – beyond the next election. Sure, not all of us can afford to invest in real estate at all, but with around $300 billion in annual tax revenues to allocate, the government is better-placed than most of us to invest wisely in the short and the long term.

Support the Cancer Council’s campaign at www.getbehindbowelscreening.com.au

Most commented

34 comments

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    • Against the Man says:

      05:34am | 13/03/12

      The ALP government only invests health dollars in keeping their corrupt nursing union buddies in the non deserved comfort zone. Royal commission anyone? Why do you think the ‘capable’ Roxon was quietly removed elsewhere?

      Reply

    • TChong says:

      08:05am | 13/03/12

      Hahahabha ( wipe away tears) hahaha !!!!!
      A royal commision?
      And you’re just the person to head it ,too Mr Mitty !
      Now, back to my “comfort zone, ” while wasting your taxpayer money.
      btw Mr Mitty,  wink

    • Flexo says:

      08:23am | 13/03/12

      TChong is that the best response you have? I call you Miss Run & Hide because you haven’t the guts to respond to your critics. Leave ATM alone because you don’t have what it takes to play with the Big Boys. How do you look at yourself without contempt each day in the mirror?

    • Greatful Dread says:

      09:37am | 13/03/12

      TChong you actually haven’t addressed the issue? Is there corruption or is that a very uncomfortable laugh to cover up the guilt? I personally would want some level of investigation of how Roxon has run the health department. All that money for so little value? This is crazy that we let politicians get away with such mismanagement.

    • Kelly from Sydney says:

      11:03am | 13/03/12

      It all comes down to money, public health investment can give a great yield but tax payer dollars are limited. A wise government that can get the biggest bang for our buck is what we want. AtM highlights an issue that even I have noticed. Everyone in health wants more but not willing to actually do more or take on more responsibility. This is wrong. TChong must be a nurse or someone who benefits from this wrong in the system because he han’t been able to justify why there shouldn’t be a royal commission into all this. If it involves tax payer money and there is even a hint of wrong doing there needs to be an investigation into the matter, if not we are no different to some corrupt third world slum.

    • Boonhauser says:

      12:54pm | 13/03/12

      Roxon would not have been moved if she was doing a good job. There is more to this story.

    • Pieman says:

      01:52pm | 13/03/12

      Wasn’t there a Federal Govenrnment in power for 13 years that was just as guilty of ‘election cycle’ politics?  Why did Costello & Howard give us our ‘coffee and a bun’ tax reduction instead of funding the National Bowel Cancer Screening Program?

      Can anything be done to raise the level of political debate and reporting in this country so that everything is not reduced to slogans, polls and the ten second grab?

      Can we make a start here?  Can any subject be discussed on this forum without petty my-team-versus-your-team sniping?

    • Against the Man says:

      03:34pm | 13/03/12

      @ TChong - So the coward returns and gets slammed! smile

      @ Pieman - This is a ALP problem and ALP corruption, to hold them not accountable means this is an illegal government. hey maybe you have a point smile

    • Mahhrat says:

      06:08am | 13/03/12

      At the risk of sounding like Acotrel, the problem with the health “industry” is it has very few KPIs.

      We look at broad statistics on a whole population and talk returns on investments and that’s well and good for an opinion piece on the punch, but where is the daily work structure that says - say, as a counsellor - that you have 5 90 minute blocks in your 7.5 hours of work, we expect you to spend an hour with four clients with 30 mins write-up, the fifth is for meetings, reviews, admin and so on?

      (Those are hypothetical numbers only and could be way off). 

      If we can just decide on what is “good enough” (remembering we’re dealing with humans and not machines) but then enforce those limits, you would at least be able to roll out best-practice models and KNOW what the health system needs.

      Reply

    • marley says:

      06:40am | 13/03/12

      While I agree with what you’re saying, I’m not entirely clear on its relevance to the article.

      It’s pretty easy to determine the impact of bowel cancer on the population - incidence, fatality rates, etc - and it wouldn’t take much more than a calculator to work out the cost of extending the screening program, or the value in lives saved and expensive treatments avoided because of early detection.

      Unfortunately, bowel cancer doesn’t get the “press” that breast and prostate cancer do, and is underfunded relative to the other two.  That needs to change.

      Incidentally, I just picked up the test kit - costs $10 in NSW, which seems a small price to pay but beyond the reach of some, I suppose, or at least not a priority.  Perhaps more needs to be done to build public awareness.

    • Kebabpete says:

      06:53am | 13/03/12

      Well said Mahhrat. It is the starting point for nearly all economic strategies and something that is done in business everyday.

      What do we want to achieve? How much will it cost? How long will it take to see a ROI?

      Just because the numbers are larger when running a country it doesn’t mean the process is any different.

      The sooner the government starts running the country like a business instead of a cash producing machine for their union buddies the better.

    • TheDishpan says:

      07:20am | 13/03/12

      Do you really want to administer the health system like a call centre?

      If you dig in an read the literature (or visit a hospital, or talk to a doctor about bulk billing, or take note the questions being asked when you make a claim against your health insurance) you’ll find that there is already a very high level of accountability and measurement in the health care system (indeed, much more than you’d see on your average private sector project). For sure improvements can alway be made but we spend way (less as a percentage of GDP) than, say, the United States and healthcare outcomes are much better.

      What you’re talking about above is measuring activity. Activity measures measure the effectiveness of management to engage in managerial activities (I tell you you can only spend 10 minutes on a call, you spend 9 minutes on a call, I say “well done, have a biscuit”, then I reduce your shifts and take a pay rise). In health (and in most public sector spending) we measure outcomes. Measuring outcome is a much sharper instrument (dare I say, scalpel) because you can correlate spending with real stuff (like the use of cheap low dosage aspirin and lower incidence of heart attack and stroke in older folk). But the real advantage of measuring outcomes over activity is that you don’t have to decide, in advance,  what is “good enough” (or “just enough”) or what is good practice (which is what you have to do when you start measuring activity).

      By the way, here’s some detail about where our health care dollars go: http://www.aihw.gov.au/publication-detail/?id=10737420435. Let’s see the private sector report like that.

    • acotrel says:

      08:09am | 13/03/12

      @The Dishpan
      I have only ever had good experiences of our health system.
      I believe that there are both positive and negative performance indicators.  I suggest the better one is measuring the outcomes/achievements of a team compared with inputs.  The emphasis on individual performance is just another way of micromanaging, it neglects the fact that as part of a team the total effect is far greater than the sum of individual performances.  The mindset in many of our businesses is wrong.  We use the old military model of command and control.  The way forward is to use information systems to train and empower and allow effective delegation. The management technique then involves asking questions and making people accountable, rather than blundering in and doing a rant and rave, which you might have to defend !

    • marley says:

      11:48am | 13/03/12

      @acotrel - thanks very much, but I personally prefer that, if I’m going to need surgery, the surgeon doesn’t delegate it to the x-ray technician or the anaesthetist.  The model you propose might be okay for a middle manager in a company where everyone is a generalist, but it’s not so hot when each member of the team is a specialist.

    • gobsmack says:

      06:54am | 13/03/12

      The detection of illnesses that can be treated is a good in itself without needing to engage in the calculus of “health economics”.
      Do the abovementioned figures take into account the money that is saved in aged pensions by not treating these illnesses?

      Reply

    • TheDishpan says:

      07:43am | 13/03/12

      @Kebabpete

      I know that management schools in the 1980s taught that mantra about private sector vs public sector effectiveness. But, having worked in some of our largest corporations on very large projects, I can tell you that it’s all a load of crap. The difference between the public sector and the private sector is transparency: in the public sector someone, somewhere will find out. In the private sector, you just roll your bad investments and decisions on to the next big project then have a party. You squeeze an imaginary 2% off of expenditure every year, fail to provision for foreseeable events (like, say, changes in law), then go running back to the trough to ask for funding. Sophisticated accounting (sophistry) lets you hide most day-to-day stuff ups from the market, which, let’s be realistic, doesn’t really challenge or punish management decisions anyway (consumers, however, do).

      Overall our governments, past and present, spend money pretty wisely (and if any $&*%er raises pink bats or school halls, you’re a tool). The proof here is that most of us learn to read and add up, we live long safe lives filled with family and meaningful employment (usually different to that of our parents), and we acquire wealth and property which we pass on to our children one way or another. In Australia we enjoy really quite incredible levels of personal choice across almost the entire income spectrum on a wide variety of matters. This is only possible in a well run state.

      Let’s stop living in this fictional world where we can compare business to government departments because they are completely different things.

      Reply

    • Winston Smith, 1984 says:

      07:53am | 13/03/12

      There was a free bowel cancer detection kit sent out awhile back as you say, I received one and put it in the drawer somewhere and I know of others who did the same thing.

      Never heard much about the results or the number of people who took up the offer and sent their sample off for analysis. 
      The bean counters would have allowed for some people opting out but again no feedback to my knowledge of the success or otherwise of the program?

      I personally prefer to make my own decisions regarding my own health outcomes. 
      I do not take kindly to being told to go do a shit on a test kit and send the results back to the government, sorry but that time will come when I think there is good reason.

      I personally think this type of thing is a gimmick and I doubt it would be cost effective.

      Reply

    • marley says:

      08:04am | 13/03/12

      I don’t understand your logic.  There’s a cheap, painless, effective way of determining whether you might have an illness at a stage when it’s treatable, and you think it’s a gimmick?  Why?  Does your wife feel the same way about Pap smears and mammograms?

    • Cynicised says:

      10:01am | 13/03/12

      There is no logic whatsoever in Mr Smith’s attitude, so don’t strain yourself looking, Marley. It’s the “ignorance is bliss” approach, ignoring the main issue with cancer that early detection has a large influence on the outcome with many forms, bowel cancer being one of the most eminently treatable.

      However, if I recall there was methodological problem with the first kits sent out so they were withdrawn and the testing suspended until the issue was resolved.

      I find the argument to increase the frequency of these tests hard to refute. As for the funding dilemmas, all I know is there is only so much pie to go around. Just how we slice it equitably is not a job I’d like to have!

    • Sophe says:

      08:03am | 13/03/12

      You need to watch Cancer Council’s TV ad about the bowel cancer screening program - it’s very moving! http://youtu.be/vLpsXBqScwU

      Reply

    • stephen says:

      08:14am | 13/03/12

      With regard to health, I don’t think that ‘cost effective’ is the best reason for deciding whether or not to get tested for a cancer.
      Preventative measures are best, especially for the onslaught that comes if the cells don’t want to behave as they should.
      But then again, if you have more important things to do, then ‘do’ away.

      Reply

    • Steve says:

      08:38am | 13/03/12

      I would ask what share of that ROI from prevention spending goes to the individual in the form of improved health and longevity- i.e a private benefit not captured by the health accounts, as opposed to reduced expenditure by the health system for treatment costs.

      The treatment providers usually point out that preventative work generally just delays the very expensive last few years of treatment at the end of a person’s life.  We still usually end up needing very expensive care at the end of life, no matter how healthy we have lived previously. 

      So preventative health expenditure delays the onset of ill-health and death - it does not delay it.

      Reply

    • marley says:

      11:52am | 13/03/12

      @Steve - well, true, but if you are diagnosed and successfully treated when you’re in your 50s, that gives you another 10 years or more to contribute to the economy and the tax base.  Or babysit the grandkids.  Or write the great Australian novel.  It seems to me that those extra years before you go into inevitable decline are valuable ones.

    • Steve says:

      12:57pm | 13/03/12

      @ Marley
      Not saying those extra years of good health are valueless, but the benefits mostly accrue to the individual, not to the health system which can’t then show the value of preventative health spending.  There is always a limied budget fo health. 

      Early detection and treatment is good for the individual if treatment works, but may actually be more expensive for the treatment system than its opposite - late detection quickly followed by death.

      Health accounting must be the grimmest subject.

    • marley says:

      01:36pm | 13/03/12

      @Steve - grim, yep. l was thinking in terms though, of that extra 10 years or so of paying income tax and GST - that’s a net contribution to the coffers of the state, and might well outweigh what you’re doubtless going to cost the system at some point anyway.

    • Steve says:

      02:55pm | 13/03/12

      @Marley
      the extra productivity shows up - if at all - in the national accounts, not the heatth sector’s accounts as a gain or saving.
       
      Regarding paying income tax for an extra ten years - most people don’t pay a lot of income tax, and most income tax comes from the top one or two deciles- who have the best health stats BTW.  Mind you salaries generally rise across working life, so income tax paid would be highest later in life when most diseases hit. 

      I distantly recall a statistic that 80+% of health spending goes on peoples’ last two years of life.  Could be wrong.

      A further fiscal consideration would be that preventative health expenditure would extend the length of time that people live to collect Australian Super.

    • Borderer says:

      08:53am | 13/03/12

      Firstly you referred to words like investment, planning and strategy. Governments don’t understand what these words mean. Health spending revolves around the screaming masses in the public system who are waiting for treatment, it’s about renumeration for workers and infrastructure (hospitals etc).
      In one respect the division of state and federal governments can help. Charge the states with operating the health infrastructure and the federal government can handle the preventative programs. The programs will be run through the states but the division of duty prevents the issue of a health minister putting a preventative measure on the back burner because of a crisis in operation of the service. It’s about focusing responsibility (another word they don’t understand).

      Reply

    • I can't read slant says:

      09:44am | 13/03/12

      AAaarrgh… Can someone put the missing closing italic HTML markup at the end of the article please?

      Reply

    • Jimbo75 says:

      10:00am | 13/03/12

      Paul,

      While I applaud your commitment I have to disagree with your proposal on two grounds.

      Firstly, I disagree that investments in early detection and prevention will save the health system and Government’s money. This analysis about savings to the health system is usually done at the patient rather than system level and so while there may be savings from not having to treat patient A, given the extensive waiting lists and the ever expanding range of treatments (and demand for these treatments), Government’s will always have to spend more and more on health systems. Let me put it this way, if the Federal Government were to roll out an expanded Bowel Cancer Screening program could they use the supposed “savings to the system” as a reason for reducing the funding they give to States and Territories to run hospitals?

      Secondly I also disagree with your claim that ” Millions are missing out on a test that could save their lives.” Exactly how are they missing out? Every Australian has two options here - either you can get tested at your GP (noting bulk billing rates for GP visits are close to 80 per cent and for pathology test are above 90 per cent) or you can get a home test kit from your pharmacy, poop on the stick and mail it away for analysis (http://www.bowelscreenaustralia.org). My understanding is that it costs somewhere in the order of $50. If bowel cancer is such a terrible disease and the benefits of early detection so big, why aren’t people asked to take responsibility for their own testing in this area? Why does the Government basically have to force people into taking a little bit of responsibility for their own health - particularly those who can afford a $50 test (or probably free if they are prepared to go through their GP) every two years.

      The claim by Health lobbyists that unless somehting is free it is inaccessible is getting tiresome.

      Reply

    • Ben says:

      12:05pm | 13/03/12

      RE: Your first point, it does have savings to the system - these are just not immediate and are delayed. The waiting lists you talk about will be reduced if cancers for example are detected earlier as the treatments at these stages are less time-consuming.

      RE: Your second point, the Government sends things like FOBT kits because people won’t use them otherwise. By sending them, more people will use them, more cancers will be detected in earlier stages, meaning more treatable cancers and less burden of disease. Giving these away does not make them accessible - it makes them accessed. And it will save the health care system money.

      The concept that prevention is better than intervention (both at the individual [quality of life] and system [economic burden of disease] translates into virtually every area of health and is an extremely important point to make.

    • Jimbo75 says:

      12:29pm | 13/03/12

      Ben,

      I don’t deny that waiting lists will be reduced but they will still existing and more people will be added as new treatments become available and people start waiting for these new treatements.

      On the second point, so because people have a tendency against using FOBT kits even through they are readily available, reasonably cheap and have the potential to give early detection of a life threatening condition the Government has to step in and pay for it? For everyone?

      Finally - I agree prevention is better than intervention but the responsibility for prevention should, in the forst instance, lie with the individual as they are the single greatest beneficiary of any prevented (or reduced severity) condition.

      If the Govt were to expand the bowel cancer screening test it should be means tested with only those who genuinely cannot afford to spend $50 once every two years getting the test for free and the remainder being afforded an opprtunity to use a Government administered system at a user pays cost.

      Anyway - that’s my view.

    • Kassandra says:

      11:42am | 13/03/12

      The article I think omits to point out that screening is only recommended in the 50 to 75 year age group, because colorectal cancer is mostly a disease in the over-50s and after 75 screening becomes much less useful as a preventative measure. Appealing as the idea is of early detection and treatment through a widespread screening programme it is inherently unlikely to really catch on, even if it gets more funding, simply because most people don’t like the test itself. I think appealing to the community is not really going to work and the effort might be more effectively focussed on getting GPs to do more screening. People are more likely to respond to their GP encouraging them to do it as part of a checkup than they are to public awareness campaigns. I don’t think funding is the main issue.

      btw can somebody turn off the italics PLEASE

      Reply

    • Ted-e says:

      03:13pm | 13/03/12

      There are more than 4000 deaths from bowel cancer each year in Australia. A comprehensive bowel cancer screening program has the potential to save at least 30 lives a week. Even the current limited program (50, 55, 65 year-olds) has a 40% participation rate and is detecting early stage cancers, so it’s already saving lives and money. Expand it to all Australians 50+, put some money into promoting it to get the participation rate up and likely it will be as successful, or more successful than breast or cervical screening.

    • Elizabeth says:

      11:27am | 11/05/12

      I don’t think any screening program should be implemented without proper assessment by an independent body, cut out politicians and those with a vested interest altogether. If the program satisfies the risk v benefit test, then it needs to be regularly reviewed and updated when necessary…and there must always be full disclosure to the target population and respect for informed consent.
      We currently have a breast screening program that will never reach it’s target of 70% of women aged 50 to 70. There is a serious cloud hanging over this testing and the profession remaining silent and playing dumb is not working, more women want the truth and are declining to test. The UK is doing a full review prompted by some amazing advocates for informed consent and after the Nordic Cochrane Institute, an independent medical research group, concluded on the evidence they cannot recommend breast screening…the benefits are very small, if they exist at all and over-diagnosis is a serious problem. Please read their excellent information sheet at their website, “The risks and benefits of mammograms”. Articles by Prof Michael Baum, UK breast cancer surgeon are also informative. I have declined breast screening, an informed decision.
      Cervical screening - we need an urgent enquiry, what’s going on with this program? It certainly does not operate in the best interests of women, but it’s fabulous for profits for vested interests. It’s a dinosaur by world standards and harms huge numbers to help a few and all with no informed consent, the lack of real information is a disgrace…women are expected to do as they’re told and file in for serious over-screening, which greatly increases the risks for no additional benefit over Finland and the Netherlands 7 pap test programs, 5 yearly from 30 to 60 - we just send huge numbers of women for unnecessary colposcopies and biopsies after false positive pap tests. The more often you screen, the greater the risk for no additional benefit. Over-treatment can damage the cervix and is linked to high risk pregnancy, premature babies, c-sections etc…
      The Health Council of the Netherlands have now recommended a move to 5 hrHPV primary triage tests offered at ages 30,35,40,50 and 60 and only those women HPV positive and at risk, about 5% of women aged 30 or more, will be offered a 5 yearly pap test. Those negative can follow the HPV program or if monogamous or no longer sexually active an forget all testing. This will further reduce pap testing, false positives, over-treatment and is more likely to prevent these rare cancers.
      No country in the world has shown a benefit pap testing those under 30 and the UK recently reviewed the evidence and concluded once again that it is unethical to test those under 25. HPV testing is not recommended for this group either as 40% would test positive, almost all are transient and harmless infections. These women are advised to see a doctor with persistent and unusual symptoms.  At the very least no young woman should be tested without proper informed consent. Instead in this country, we scold young women who choose not to screen….IMO, we provide bad medical advice to all women, young and older women.
      The Dutch also have a self-test HPV option, the Delphi Screener…also available in Singapore and elsewhere.

      Our doctors are silent and collect target payments for pap testing, recently the target rose to 70% of eligible patients, no doubt in response to a fall in the screening rate to 57% of women. Hopefully, more women are working out this program is not operating for our benefit. Please do your reading and make informed decisions about screening. No woman needs an absurd 26 pap tests…

      I’ve read bowel cancer screening does not change all cause mortality….please, no more screening until the proposed program has been independently assessed and if it passes, it must then be properly and independently monitored to keep vested, political and other interests in line.

      Reply
 
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