As I indicated in an earlier article, the recent report recommending that women delay their mammograms would herald in a new approach to healthcare provision in America – delaying services. After the breast cancer report was discussed extensively in the media, another report came to the forefront again recommending that women delay screening services but this time to identify cervical cancer. This “wait ‘til later approach” is dangerous in healthcare as well as in education. The purpose of routine screenings is to determine if there are early signs of a disease or a disorder. The better the screening technology, the fewer the instances of false positives and/or false negatives but that’s not the issue.
If we do not screen and we wait, there is increased risk to a patient’s prognosis. Obviously a person with breast cancer will be more easily diagnosed when she has stage 4 than when she has stage 1 breast cancer. Delayed screenings create greater medical costs since later diagnoses are much more difficult and expensive to treat. In addition, there is a much greater threat to the life of patients the longer a disease and/or disorder remains untreated. So, is there an immediate cost saving if screenings are delayed? Yes. But what you ignore today you will pay for later in increased deaths and health costs.
The public is not being told that with this “recommendation” comes the unspoken reality that major medical carriers might not reimburse for these services because they are no longer customary and usual. The delay in screenings focuses on money and not on the importance of early identification. The question is what will the future medical system “look like” with delays in screening services? Where is this going? We have an existing program that presents many insights about how medical services could be provided and who will receive them – the early intervention system for infants and toddlers.
For the past 30 years, physicians and clinical practitioners have utilized screening programs to identify infants and toddlers with developmental disabilities. We have national programs which specifically target families at-risk in urban communities. Infants and toddlers are screened to identify physical, cognitive, social and communication deficits. But even with these programs, infants and toddlers are turned away from the early intervention system. Why? Simply put, their “developmental problems” do not reach a threshold to warrant services. The recommendation to families is to come back in six months to determine if the problem is worse. If the child does not have a 33% disability, then families must wait until the child is older. This is what lies ahead for healthcare services.
Although routine screenings may not be sensitive enough to accurately identify every patient, the recommendation to delay the screening process is not acceptable. With infants and preschoolers, we cannot wait. So what will happen in the future for infants? To save money, the early intervention system could raise the threshold and require a 50% or a 60% disability before early intervention services can be provided. How disabled does a child have to be before he receives early intervention services? How long will children have to wait to receive services? Let’s be honest, medical screenings are being delayed because early intervention cannot occur without them. How much is a life worth? Particularly if it’s your life or your child’s life?