A preventive examination is a pointless exercise

Cancer survival rates in the U.S. are higher than ever and death rates are falling, according to the latest data from the American Association for Cancer Research. The 5-year survival rate, one of the main indicators in such analyses, has risen from 49% in 1970 to 70% in the past decade.

The data from all developed countries are similar, and the explanation is complex. For the last 50 years, progress in medicine, technology and pharmacy has been significant, the same applies to the prevention of diseases – in Western countries, for example, smoking is decreasing.

However, the report of the American association says something else – the decreasing death rate from cancer is also due to improved prevention, early detection and treatment.

In Bulgaria – expectedly – the survival rate is lower than the average in the EU and there are not even particularly up-to-date official analyses. The Ministry of Health itself cites data from the long-defunct National Cancer Registry.

According to the latest data – from 2017, the most common cancer in women in our country is breast cancer. 5-year survival is 72% compared to nearly 84% in Europe.

Among men, prostate cancer is at the forefront. The 5-year survival rate in our country is 53%, as much as 30% less than the European average.

And one more number. The percentage of people visiting their GP for their mandatory annual check-up has probably never been above 40% since we had GPs. Specifically for 2021, they are 36%.

The connection is obvious and has long been proven. Late detection of diseases leads to more difficult and expensive treatment – not only of oncological diseases, but also of all diseases. However, since everyone is aware of this – patients, institutions, and doctors – why do only about a third of the people in Bulgaria enjoy their right to a preventive examination?

In fact, we are also talking about an obligation. According to the Law on Health Insurance, patients are obliged to fulfill the requirements for prevention, and if they do not attend preventive examinations, they lose their insurance rights for a period of one month.

However, no one has ever been punished for such a thing, and the absentee dispute between doctors and patients over whose initiative should be is a long-standing one. People expect the jeeps to call them, and the doctors explain that it is the patient’s duty and they cannot force anyone to appear.

The main problem, however, is the motivation – of both general practitioners and patients. For decades, the preventive examination by the health fund has covered almost nothing and in the mass case it seems like a waste of time for both parties.

The insured person, especially if he is under 40, gets a free blood pressure measurement and ECG and possibly a urine test with test strips. Once every 5 years, a blood test is also taken.

For men over 40 and women over 50 – once every 5 years, cholesterol and triglycerides are tested. Women aged 30 to 40 have the right to a gynecologist examination and Pap smear, those aged 50 to 69 – to a mammogram once every two years, and men over 50 – to a PSA test for prostate cancer, again every 2 years .

Only after the age of 65 are blood tests done annually.

And only from this year, the general practitioner has the right to send women between 30 and 50 years old for a preventive ultrasound for breast cancer – once every 2 years.

That is, until recently, if a woman under the age of 50 wanted to have a preventive examination for breast cancer, she had to either pay for it or go through an endlessly complicated procedure – her personal doctor sent her to a gynecologist, who in turn gave her a referral for ultrasound or mammography to a mammologist. The AG specialist cannot be skipped, since the jeep is not allowed to give coupons for such tests.

The other types of cancer are not considered to be subject to preventive surveillance at all, despite their higher frequency – for example, colorectal cancer. The fact that regular preventive examinations for cervical cancer, i.e. Pap smears are applied only to women aged 30 to 40.

As well as that they are the only ones who have access to a preventive examination by a specialist – AG. Everyone else goes to a cardiologist, endocrinologist, or GP only if they have complaints.

The patients’ interest in the already tiny prophylactic package is also indicative. Although they have the right to a free mammogram, in recent years about a quarter of women between the ages of 50 and 69 take advantage of it and go for the preventive examination. A prostate cancer test is done by about a third of the men who are asked to do so. Probably, some of them do not even suspect that such a thing is being done to them.

Therefore, only this year, the health insurance fund tried to create additional incentives for private doctors and the payment of the preventive examination is now according to the scope of the examinations. Until 2022, doctors received BGN 18 for each reported preventive examination. Now the amount can be BGN 26, if more than 60 percent of the doctor’s patients have passed through the doctor’s office for a similar examination. If they are from 46 to 60 percent – the amount is BGN 25, and if they are less – BGN 20.

To what extent the latest innovations will change something, it remains to be seen, but it is obvious that with such a package and with such vague obligations and responsibilities of both parties, this is also the prevention in our country.

However, we should not forget that there is a third participant in this process, whose interest in early detection of diseases should be no less. These are the financing institution – the health fund and the state as a whole.

The money given by the NHIF for early detection of diseases would return many times over as savings later on expensive treatment and hospitalizations.

The state, on the other hand, is the one that must invest resources for disease prevention and mass screenings – which are also almost lacking in our country. This pays off over time in the form of lower mortality, longer life expectancy, lower disability and, accordingly, greater work capacity.

However, both the health fund and the state have left the prevention and prophylaxis of socially significant diseases mainly in the hands and pockets of patients. The result has been unchanged for years – Bulgaria is among the countries with the highest levels of hospitalizations and mortality in the EU.

By which we prove empirically that when you leave salvation in the hands of the drowning, they drown.


The article is in bulgaria

Tags: preventive examination pointless exercise

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