Bureaucratic System in Ireland Affects Access to Pap Testing

WHEN IT COMES TO CERVICAL CANCER SCREENING IN IRELAND, health system bureaucrats have put some of the nation’s women into the perfect “Catch 22.”

As this happens, it provides another case study of why a government health system can often create coverage rules and restrictions which run contrary to common sense in patient care, while at the same time creating more complexities in the daily interaction between physicians and their patients.

It was just over one year ago, on July 1, 2008, when the Irish health system out- sourced 100% of the nation’s Pap testing to United States-based Quest Diagnostics Incorporated. The stated reason for this action was that it took an average of six months—and sometimes as long as one year—for Irish labs to report Pap test results to referring physicians. Under the new, multi-year contract, Quest Diagnostics pledged to report Pap tests within 10 days.

Solving The Six-Month TAT

This action was not popular with the nation’s physician associations nor the pathology profession. However, on the surface, this decision by the government health system did appear to solve the ongoing problem of the six-month wait for Pap test results that was the status quo.

But now comes the Catch 22 moment. Over the past 24 months, the Irish health system has created a new national cervical cancer service called CervicalCheck. It is administered through the National Cancer Screening Service (NCSS).

Under its coverage guidelines, women aged 25 to 65 can get cervical cancer screening services “for free” under the CervicalCheck program. But they must first register themselves with CervicalCheck. Once registered, they will get “invitations” (appointments) for an office visit with their physician to undergo screening.

Open Access For One Year

During a one-year transition period ending September 1, 2009, CervicalCheck was an open access program. This provided time for women to register. As well, during this year, any unregistered woman between 25 and 65 visiting a physician could have a cervical cancer screen.

That stopped on September 1, 2009. Now, when a woman visits her physician, she cannot get a cervical cancer screen unless she is registered with CervicalCheck and has an invitation. In recent weeks, primary care physicians complained loudly to the Irish press that, as unregistered patients show up in the clinic wanting their regular cervical cancer screen, the physicians must turn them away because of the Irish health system’s requirement for pre-registration.

And here is the Catch 22. As reported in August by the Irish Times, “…the letter to GPs [General Practitioners] from the CervicalCheck National Cervical Screening Programme (NCSP) states that, during the initial transition period, [unregistered] women requesting a smear test are likely to have to wait six months.”

This brief overview of the ironic developments in Ireland illustrates why “Catch 22” aptly describes the situation, since arbitrary new rules mean that a woman unregistered by CervicalCheck will need to wait six months before she can get an appointment for her cervical cancer screen!


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