By Alyce Vella, Health Promotion Worker
Proposed changes to pap screen bulk-billing will have a significant impact on women who work, play and reside in the west, and will likely further exacerbate health inequity among women who experience disadvantage. Changes could result in patients paying up to $30 for a pap smear.
Only 58 per cent of women aged 20-69 participated in the National Cervical Screening Program in 2012-2013. Rates of screening among women residing in the western region of Melbourne are lower than the national average; as low as 44 per cent in some local government areas. It is likely that this number will reduce even further if added financial pressure is placed on women, let alone the increased effort required to identify a bulk-billing clinic if clinics increase their patient contribution.
Who will be impacted?
Marginalised community groups who are already presenting at low rates for pap screens are likely to be impacted, including Aboriginal women, migrant and refugee women, young women, women with a disability, lesbian and bisexual women, and victims/survivors of sexual violence. Incidence and mortality outcomes among Aboriginal women are particularly dire; Aboriginal women are 2.3 times more likely than non-Aboriginal women to develop cervical cancer (incidence rate), and almost 3.5 times more likely than non-Aboriginal women to die from cervical cancer, highlighting an already significant gap in health care among this community group.
Why the change?
One of the arguments for the proposed changes is that increased accessibility to the Human Papilloma Virus (HPV) vaccine (which protects against the high risk HPV strains that play a large role in the development of cervical cancer) is likely to see a reduced incidence of cervical cancer in the future, reducing the demand for pap screens. However, it is important to note that routine pap screens with a nurse or GP often act as a mediator for discussions about other routine health checks, such as breast screening for older women and STI testing for sexually active women, particularly for young women who are at highest risk of STIs such as chlamydia. With rates of chlamydia in some parts of Melbourne’s west almost three times greater than the state average, these opportunistic discussions are vital to the sexual and reproductive health of women in the west.
Arguably the most important concern with the proposed changes to pap screen bulk-billing are the potential impacts on women seeking out health care in a timely, preventative manner. According to the Victorian Cervical Cytology Registry, ‘almost 90 per cent of all Victorian women who develop cervical cancer have either never had a test, or did not have a test routinely in the ten years prior to their diagnosis’, highlighting that the additional barriers to screening, such as the ones proposed, are likely to result in even more alarming statistics.
Increasing culturally appropriate and responsive cervical screening service delivery and coordination throughout Melbourne’s west is an objective of Action for Equity, the sexual and reproductive health plan for Melbourne’s west. The Action for Equity partnership is led by Women’s Health West.
- Department of Health 2014: Victorian Notifiable Infectious Diseases Surveillance database (via the Victorian Women’s Health Atlas)
- Victorian Cervical Cytology Registry 2013: Statistical Report (via the Victorian Women’s Health Atlas)
- Women’s Health Victoria 2015: Victorian Women’s Health Atlas
- Australian Institute of Health and Welfare 2015: Cervical screening in Australia 2012–2013
- Cancer Australia 2016: Aboriginal and Torres Strait Islander cancer statistics