Policy Alternatives to Address the Problem of Low Compliance with Colorectal Cancer Screening Guidelines in Massachusetts

Link to full report

Executive Summary

The Problem: If detected early, colorectal cancer (cancer of the colon and/or rectum) has a 90 percent cure rate (National Colon Cancer Research Alliance 2011), but because of low rates of screening compliance it remains the second leading cause of cancer-related deaths in the nation, accounting for 10 percent of cancer deaths overall (Ziegler et. al. 2010). The present report examines the reasons behind the lack of adherence to CRC screening guidelines and explores policy alternatives for increasing compliance with these guidelines in Massachusetts, including best practices used in other states.

Policy Alternatives: The following policy alternatives for improving compliance are proposed in this report: 1) The passage of “An Act Ensuring Access to Life-Saving CRC Screenings” (H.B. 2185) which would mandate that insurance companies cover colorectal cancer screening in Massachusetts according to national guidelines; 2) state initiatives to educate the public including social media marketing and the internet; 3) tracking appointment-keeping behavior to predict which patients need additional follow-up; 4) improved communication between patients and physicians using a “peer coach” model such as the Patient Navigator Program at Massachusetts General Hospital; 5) continuing education programs for physicians; and 6) enhancing free screening programs in Massachusetts.

Criteria for Evaluation: The above policy alternatives are evaluated on the basis of three criteria: 1) Economic efficiency; 2) fairness and equity; and 3) feasibility. We conclude that mandating coverage is the most economically efficient policy alternative. Tracking patients’ appointment-keeping behavior and implementing a comprehensive CRC screening program that offers free screening for those who cannot afford it are the most equitable alternatives. A coverage mandate and the use of social media are the most feasible. (Please see Appendix B for a breakdown of the ratings for these criteria).

Projected Outcomes: We discuss expected opposition to our policy alternatives (particularly economic cost) as well as expected support and positive externalities including the diagnosis of other diseases that can be detected through CRC screening.

Policy Recommendation: Our recommended policy solution is to implement a comprehensive program for CRC education, prevention, and early detection in Massachusetts that incorporates all of our policy alternatives since they each have their unique advantages.

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