Unlocking Colonoscopy Access: Bridging the Geographic Divide
The stark reality: Your location shouldn't dictate your access to potentially life-saving colonoscopy services. Yet, new data reveals a concerning trend in Australia, where the availability of Medicare Benefits Schedule (MBS)-subsidised colonoscopies varies significantly across regions, and these disparities have widened over the past ten years.
As a medical professional, I've noticed two distinct trends in patient conversations about colonoscopies. Firstly, there's a surge of interest among those with no apparent symptoms or risk factors, possibly influenced by media coverage of bowel cancer. Secondly, convincing patients over 45 to participate in regular bowel cancer screening with faecal occult blood tests can be challenging.
But here's where it gets intriguing: This mismatch between concern and clinical need isn't isolated to my practice. It's a national issue, and it's crucial to ensure that colonoscopies are performed when medically necessary, without overburdening the healthcare system.
The Atlas of Healthcare Variation report (https://www.safetyandquality.gov.au/our-work/healthcare-variation/atlas-focus-report-colonoscopy) paints a revealing picture. It shows that major cities have higher rates of MBS-subsidised colonoscopies, despite higher bowel cancer mortality rates outside these urban centers (https://www.aihw.gov.au/reports/cancer-screening/nbcsp-monitoring-2025/data). And when we factor in socioeconomic status, the most disadvantaged areas have the lowest colonoscopy rates, further emphasizing the mismatch between access and need.
And this is the part most people miss: By examining colonoscopies repeated within a short period, we can gain deeper insights. The Guidelines for surveillance colonoscopy (https://www.cancer.org.au/clinical-guidelines/bowel-cancer/surveillance-colonoscopy) recommend repeat procedures before three years only for a small group of high-risk individuals. However, the Atlas data reveals discrepancies based on rurality and socioeconomic status, even for these repeat colonoscopies.
A Growing Disparity:
The trend data in the Atlas report indicates that this variation has intensified over the past decade. While the national rate of MBS-subsidised repeat colonoscopies before three years decreased by 8% between 2013-14 and 2023-24, the changes vary significantly depending on location and socioeconomic status:
- Major cities saw a 6% decrease, while remote areas experienced a 26% drop.
- The most disadvantaged areas had a 17% reduction, while the least disadvantaged areas showed a 2% increase.
These figures suggest that access to repeat colonoscopies is not equitable, and some individuals may be undergoing the procedure too early, especially in more affluent regions.
Unraveling the Causes:
Several factors contribute to these variations in MBS-subsidised colonoscopy and repeat colonoscopy rates:
- Healthcare Infrastructure: Availability of clinicians and health facilities in certain areas.
- Financial Barriers: Out-of-pocket costs may deter some individuals from accessing colonoscopies.
- Awareness and Participation: Knowledge of bowel cancer symptoms and engagement in screening programs.
- Logistical Challenges: Transportation and other access barriers.
- Alternative Funding Models: Colonoscopies funded through sources other than the MBS.
Working Towards Equity:
Addressing these disparities requires a comprehensive, sustained approach. The Gastroenterological Society of Australia's (GESA) Regional, Remote, and Indigenous (RRI) program (https://www.gesa.org.au/education/rural-remote-and-indigenous-program/) is making strides by establishing Fellowship training positions and conferences in regional areas, fostering workforce development and addressing health disparities.
Additionally, financial incentives and outreach programs are essential to increase colonoscopy rates in underserved areas. General practitioners play a vital role in encouraging patients to participate in the National Bowel Cancer Screening Program, as current participation rates are relatively low (https://www.aihw.gov.au/reports/cancer-screening/nbcsp-monitoring-2025/contents/data-at-a-glance/latest-nbcsp-performance-indicator-results).
While increasing access in some regions, we must also address inappropriate colonoscopy use in others. This is not only about efficient resource allocation but also about patient safety, as unnecessary procedures carry risks, albeit rare.
The recently updated Colonoscopy Clinical Care Standard (https://www.safetyandquality.gov.au/standards/clinical-care-standards/colonoscopy-clinical-care-standard), released alongside the Atlas Focus Report: Colonoscopy, sets a national benchmark for quality colonoscopy services. It mandates processes for referral, credentials, procedure, communication, and follow-up, ensuring a consistent standard across Australia.
The Standard addresses two key issues contributing to early repeat colonoscopies: access to previous colonoscopy reports and adherence to surveillance guidelines. Colonoscopists are now required to locate previous reports and ensure compliance with Clinical practice guidelines for surveillance colonoscopy (https://www.cancer.org.au/clinical-guidelines/bowel-cancer/surveillance-colonoscopy) before scheduling repeat procedures.
To further mitigate this issue, the Standard guides health services and clinicians on best practices for reporting and follow-up, including uploading colonoscopy reports to both patient records and shared record systems like My Health Record.
Additionally, the Standard emphasizes the importance of clear communication between colonoscopists, patients, and their GPs regarding colonoscopy results, histopathology findings, and ongoing surveillance needs, which is crucial for preventing unnecessary repeat procedures.
Local Insights, National Impact:
Healthcare providers can utilize the interactive data in the Atlas report to identify colonoscopy and repeat colonoscopy rates in their area, pinpointing gaps in care. Reflecting on these variations and taking action is essential to improve equity.
Since 2018, the Colonoscopy Clinical Care Standard has been instrumental in delivering high-quality colonoscopy services to all Australians. However, the new Atlas Focus Report: Colonoscopy highlights a growing divide in colonoscopy rates, underscoring the need for a united effort to ensure equitable access to quality colonoscopy services across the country.
About the Author:
Dr. Phoebe Holdenson Kimura is a Medical Advisor to the Australian Commission on Safety and Quality in Health Care and a dedicated general practitioner based in Sydney. Her insights are independent and unbiased, reflecting her commitment to improving healthcare access and quality.
