Lessons In Lab Testing From Ireland

IN REAL TIME, PATHOLOGISTS ACROSS THE GLOBE CAN WATCH the meltdown of the Irish Health Service Executive’s ambitious effort to revamp cervical cancer screening services in the country. It reorganized these screening services in order to achieve its declared goal of reducing death rates in Ireland from cervical cancer to rates at or below the average of the European Union.

So far, the new cervical cancer screening program, called CervicalCheck, has found few supporters within the Irish healthcare profession. In 2008, it alienated pathologists and laboratory scientists by outsourcing all the nation’s Pap testing to Quest Diagnostics Incorporated in the United States. That act also set an international precedent, as it marked the first time that a government health pro- gram in a developed country chose to send all its specimens for an important diagnostic test to an overseas laboratory.

Since the fall of 2009, the CervicalCheck program has alienated general practitioners (GP) in Ireland. That happened when the government unilaterally changed both the way GPs are paid for providing cervical cancer screening services and by requiring GPs to deny free screening services to women who show up in their medical clinic, but who are unregistered with CervicalCheck.

Ireland has the same challenge as every developed nation in the world. Demand for healthcare services increases year-by-year at a rate which exceeds the ability of the government health program to adequately pay providers for this care. Thus, how elected officials and health department bureaucrats set policies for coverage guidelines and reimbursement in such situations gives us a hint of how politicians in other nations may respond to this same situation.

There is additional irony to the Irish Pap test situation. Irish health bureaucrats justified the Pap test outsourcing and the creation of CervicalCheck by stating that the average Pap result turnaround time of six months was intolerable. Its chosen lab vendor, Quest Diagnostics, would have to meet a 10-day turnaround time for Pap results. However, now CervicalCheck requires women to register— then wait as long as six months—for the “invitation” which allows them to then make an appointment to see their doctor for their screen. Thus, newly-registered women are now forced to wait as long as six months for their invitation! Plus, women who are unregistered, but show up in the doctor’s office, will be denied the free cervical cancer screening service. I don’t think this was supposed to be the way any nation’s promise of universal healthcare was to be kept.