Northland MP and Associate Health Minister Willow-Jean Prime is responsible for women's health matters. Photo / Michael Cunningham
Northland MP and Associate Health Minister Willow-Jean Prime is responsible for women's health matters. Photo / Michael Cunningham
Health officials want to make cervical screening free for all women and are seeking “sustainable long-term funding”, documents reveal.
Currently, the National Cervical Screening Programme receives $45 million in annual baseline funding, which isn’t enough to make screening free.
Most women must therefore make a “co-payment” to their GP orprimary healthcare provider, which according to health officials can range from around $40 to $100.
Cervical screening is the only national screening programme that isn’t free.
Health NZ - Te Whatu Ora briefed Health Minister Ayesha Verrall last September, and stated that, in the longer-term, “the National Screening Unit are working across Te Whatu Ora to determine how the impact of co-payments can be reduced”.
“Te Whatu Ora is in the process of modelling draft cost options and will be looking for opportunities for sustainable long-term funding to support a free National Cervical Screening Programme,” stated the document, obtained under the Official Information Act.
That work seeks to make the most of a major shift in the screening programme. From July 26, the primary test will test for the presence of human papillomavirus (HPV).
Self-testing will be an option, with a vaginal swab taken by the participant in privacy at a health clinic, or taken by a clinician. This could also be done at someone’s home.
Detection of HPV would require follow-up testing, such as a speculum exam or colposcopy.
The accuracy of HPV testing will mean routine screening will be needed once every five years. The current timeframe is every three years.
Act Party health spokeswoman Brooke van Velden: "‘Free’ prescriptions and ‘free’ cervical screening come at a cost to other services.” Photo / Mark Mitchell
The Government aims to reach 80 per cent screening coverage for eligible women.
As of March, 67.5 per cent of eligible women had been screened within the previous three years. This reduced for Māori (55 per cent), Pacific (55.9 per cent), and Asian (59 per cent). The ‘Other’ rate was 74.6 per cent.
“Priority” women are screened for free, including Māori, Pacific, Asian and “under-screened” women, who haven’t been tested or are significantly overdue.
Asian women - a statistical grouping covering a vast range of ethnicities and resident histories - will lose that status from next month, under a proposal from Te Whatu Ora, which says their cancer rates aren’t higher than ‘Other’ groups, unlike Māori and Pacific.
Under-screened Asian women would still be a priority, Te Whatu Ora stresses. However, the Federation of Women’s Health Councils says the change is a backwards step.
Barbara Robson, federation co-convenor, said the switch to HPV testing is an ideal time to make screening free for all women - not reduce the “priority” definition.
“It seems that women are still at the forefront of government cost-cutting measures despite the talk of a women’s health strategy and achieving equity.”
The law requires the cervical screening programme to be reviewed every three years, and the Health Minister appoints an expert panel to do so.
The latest report was published last month, and highlighted “unacceptable inequities”, including for Māori women, who are 2.3 times more likely to die from cervical cancer.
“While there has been steady improvement in cervical cancer incidence and mortality rates since the programme’s inception [in 1990], the last few years have seen results plateau and in some areas even decline,” the report warned.
Its recommendations included eliminating costs for all women by 2024.
“Currently available free screening funding falls short of requirements to reach all priority people, and the method of allocation creates confusion for some service providers,” the report stated.
“Priority group people are generally unaware they may be eligible for free screening. These factors lead to inconsistent access of free screening.”
In response, Te Whatu Ora accepted the recommendations, “but notes that our ability to implement some recommendations - particularly to provide a free cervical screening programme - is dependent on securing additional funding.”
Astrid Koornneef, Te Whatu Ora’s interim director prevention, told the Weekend Herald it would cost an estimated $20m extra a year to make screening free to all.
Modelling hasn’t been done around how many more cancers this would detect.
“Te Whatu Ora is exploring opportunities to deliver cervical screening that is free to the participant, with a particular focus on priority groups who experience inequities in access to cervical screening, and in cervical cancer incidence and outcomes,” Koornneef said. “This includes securing the necessary funding.”
New Zealand First leader Winston Peters wants cervical screening to be free for all women. Photo / Alex Burton
Political reaction
Associate Health Minister Willow-Jean Prime said $53m from Budget 2021 was put towards moving to HPV screening, and this alongside wider reforms would help improve equity.
“I’m aware that Te Whatu Ora is exploring the opportunities provided by HPV primary screening including delivering a programme that is free to the participant, and how funding can be secured for this.
“The particular focus is on priority groups who experience inequities in access to cervical screening, and in cervical cancer incidence and outcomes. I look forward to receiving the update on this kaupapa.”
National
Health spokesman Dr Shane Reti said if in government National “will explore screening options across a range of conditions”.
National has already announced increasing breast cancer screening from 69 to 74 years, Reti said, and will announce more health policy soon.
He is concerned about the “slow” progress on HPV screening, including self-testing.
Act
Health spokeswoman Brooke van Velden noted advice from Te Whatu Ora for women to seek out low or no-cost screening, available through providers including Family Planning.
“Co-payments … are low to non-existent already, so why is there a need to make it free? ‘Free’ prescriptions and ‘free’ cervical screening come at a cost to other services.”
Act would prefer that the money be targeted. For instance, by paying GPs more “so people can actually see a doctor”, and making screening free for women who can’t afford a co-payment.
The Green Party
Health spokesman Ricardo Mendez March said the party wants free cervical screening, more education about the self-administered testing option, and culturally-appropriate outreach for under-screened women.
“Additionally, cervical screening by a health professional should be automatically offered free of charge when an IUD is inserted or removed.”
NZ First
Wants screening to be free for all women. “Access to first world healthcare and clinical outcomes should not be confined to those that can afford the service but be accessible to women no matter their economic or ethnic background,” said leader Winston Peters.
The Opportunities Party
TOP wants free screening for all women, available in all clinics. This should cover consumable costs so GPs don’t pass on charges, the party says, and there must be a “for-Māori/Pasifika and by-Māori/Pasifika approach to increase uptake”.
