Colonoscopy access: Postcode and pay packet still dictate outcomes

A new report from the Australian Commission on Safety and Quality in Health Care has revealed widening inequities in access to colonoscopy services, with significant differences depending on where people live and their socioeconomic status.

Almost one million colonoscopies are performed across Australia each year, the majority in private hospitals and day hospitals. Between 75% and 80% of all procedures are carried out in private settings, compared to just 20–25% in public hospitals. While colonoscopies in private facilities are subsidised under the MBS, patients still face out-of-pocket costs, creating an additional barrier for many.

The Commission released both its latest data report and an updated Clinical Care Standard for colonoscopy yesterday at the combined World Congress of Gastroenterology and Australian Gastroenterology Week (AGW) in Melbourne.

The findings highlight that the national rate of repeat colonoscopy within three years has fallen by 8% in the decade to 2023–24. The sharpest declines occurred in remote areas (down 26%) and among populations experiencing the greatest socioeconomic disadvantage (down 17%).

Conjoint Professor Anne Duggan, CEO of the Commission and a gastroenterologist, emphasised the importance of timely and appropriate access.

“The Atlas Focus Report highlights a widening gap in colonoscopy rates. People living in cities and more affluent areas are having more MBS-subsidised colonoscopies than those in both rural and disadvantaged areas,” Professor Duggan said.

“Colonoscopy is one of the most powerful tools to prevent and detect bowel cancer early. We want to make sure every colonoscopy is done for the right reason, at the right time and to the highest quality.”

Disparities were evident not only in repeat colonoscopies but also in overall rates. People in major cities underwent colonoscopies at four times the rate of those in remote areas, while patients in affluent areas had nearly double the access compared with those in disadvantaged communities.

The report pointed to a mix of consumer and system factors driving the divide. For patients, these include the ability to pay out-of-pocket costs, take time off work, or maintain private health insurance with adequate cover. Awareness of bowel cancer symptoms and participation in the National Bowel Cancer Screening Program (NBCSP) also influence uptake.

On the system side, inequities are shaped by MBS subsidisation differences across states and territories, outpatient waiting times, the fee-for-service model, workforce and infrastructure shortages in regional and remote areas, and weaker governance of private colonoscopy services that can result in procedures being performed earlier than clinical guidelines recommend.

Professor Ben Devereaux, gastroenterologist at Royal Brisbane and Women’s Hospital and the University of Queensland, stressed that these disparities are particularly concerning in underserved areas.

“When colonoscopy services are limited, such as in rural areas, it’s even more important that we provide services to those with greatest need. We also need to inform patients about risk and benefit. Currently only 2 out of 5 people of those invited participate in the National Bowel Cancer Screening Program.”

Dr Phoebe Holdenson Kimura, Medical Advisor for the Commission and a general practitioner, underlined the preventive power of screening.

“You may not have cancer, but the colonoscopy might find pre-cancerous growths that can be removed. To reduce your risk, do the bowel cancer screening test if you are 45 to 74 years, and have a colonoscopy if the test is positive. After that, have repeat colonoscopies when recommended.”

Bowel cancer remains Australia’s second-biggest cancer killer, costing the health system more than $1.7 billion each year. While survival rates are steadily improving, mortality remains disproportionately higher in regional and remote communities and in lower socioeconomic groups.

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