New data indicates significant and growing disparities in access to MBS-subsidised colonoscopy services across Australia. The latest Atlas of Healthcare Variation report highlights that rates of colonoscopy are higher in major cities and affluent areas, despite higher bowel cancer mortality rates in remote and socioeconomically disadvantaged regions. These gaps have reportedly expanded over the past decade.
Key Findings from the Atlas Report
The report identifies a clear pattern: major cities show higher rates of MBS-subsidised colonoscopy compared to other areas. Similarly, the most disadvantaged areas exhibit the lowest rates. This contrasts with bowel cancer mortality, which is higher outside major cities and in disadvantaged areas.
Analysis of repeat colonoscopies before the recommended three-year interval also reveals discrepancies. While the national rate for repeat colonoscopies before three years decreased by 8% between 2013–14 and 2023–24, this change varied significantly:
- Major cities experienced a 6% decrease, while remote areas saw a 26% decrease.
- The most disadvantaged areas recorded a 17% decrease, whereas the least disadvantaged areas observed a 2% increase.
This suggests that access to necessary repeat colonoscopies is uneven, and some individuals in affluent areas may be undergoing procedures earlier than clinically indicated.
Reasons for Variation
The observed patterns in colonoscopy rates may stem from several factors:
- Availability of clinicians and health facilities.
- Ability to cover out-of-pocket costs.
- Public awareness of bowel cancer symptoms and participation in screening programs.
- Logistical barriers to access.
- Funding through models other than the Medicare Benefits Schedule (MBS).
Efforts to Improve Access and Appropriateness
Addressing these inequities requires a multi-pronged strategy. Initiatives like the Gastroenterological Society of Australia's (GESA) Regional, Remote, and Indigenous (RRI) program are working to develop the workforce and reduce disparities in remote communities. Systemic changes, including financial incentives and outreach programs, are also deemed necessary to increase rates in underserved regions.
General practitioners play a crucial role in encouraging participation in the National Bowel Cancer Screening Program, which currently sees only two in five eligible individuals participating.
Simultaneously, efforts are underway to reduce inappropriate colonoscopy use. The revised Colonoscopy Clinical Care Standard, released in September 2025 alongside the Atlas Focus Report: Colonoscopy, aims to ensure high-quality care. This standard mandates processes for referral, credentialing, procedure execution, communication, and follow-up. It specifically guides clinicians to review previous colonoscopy reports and confirm alignment with surveillance guidelines before scheduling repeat procedures. The standard also emphasizes clear communication of findings and follow-up plans to both patients and their GPs, often by uploading reports to shared health record systems such as My Health Record.
Healthcare services and clinicians are encouraged to use the interactive data in the Atlas report to assess local colonoscopy rates and address any identified gaps in care. A unified effort from the healthcare system and clinicians is vital to ensure all Australians have equitable access to high-quality colonoscopy services.