Search

The logistics of complying with current American Cancer Society breast cancer screening recommendations in a large health maintenance organization, serving more than 50,000 women age 40 or older, are described. An alternative screening approach estimated to be at least as health-effective as the American Cancer Society recommendations has been developed and appears to solve the problem and is financially feasible. Cost-effectiveness depends on optimal use of mammography and health-care personnel resources. The authors show how the start-up and maintenance costs of an organized program can be offset by future cost savings resulting from reduced long-term disability in patients diagnosed at Stages 0-1 as opposed to Stages 2 and later. Careful selection of the delivery model before implementation can make a breast cancer screening program cost-effective as well as health-effective.

The shift in emphasis towards disease prevention and health promotion is forcing changes in the traditional health provider model. At Group Health Cooperative of Puget Sound (GHC), a 349,000 member staff model HMO, consensus development on health promotion issues is the responsibility of a permanent Committee on Prevention (COP). By spreading the workload over multiple subcommittees that involve cross-sections of the medical, nursing, and other professional staff, the COP has prepared the groundwork for a number of major health care decisions at GHC. The COP has also been the starting point for programs such as the GHC Breast Cancer Screening Program, colon cancer screening, a senior influenza immunization program, and an institutional ban on smoking.