intended to promote health outcomes rather than simply document possible disease for compensation purposes.

In this chapter, we address compensational screening. This is the use of medical tests and administrative qualifications to identify individuals who might be candidates for compensation under RECA. This concept is required because RESEP specifies screening for some diseases not traditionally recommended for medical screening to improve health outcomes. Because a term is required to describe this RESEP concept, we coin the term compensational screening. RECA provides compensation for certain radiogenic and nonradiogenic diseases. Some individuals may wish to be evaluated to establish eligibility for compensation, and RESEP provides a mechanism for such evaluation.

RESEP also provides means of organizing direct or referral care for at least some screened individuals who are found to have abnormalities that need further investigation. It is not, however, specifically mandated to provide care to such persons (who might then be regarded as patients). As noted in Chapter 11, some HRSA grantees with RESEP awards apparently leverage their grant awards to provide at least some medical services to some patients under various arrangements for those with or without health insurance. Nonetheless, even though RESEP is identified as a medical screening program, it is properly seen more as a compensational screening program. Moreover, RESEP was not established to be a provider of medical services (of last resort or otherwise), although one interpretation of the services rendered is that they are meant to enhance prevention.

If populations in the RESEP screening program are medically underserved or reluctant to contact the medical system, diverting resources or providing additional resources to facilitate such contact might be more beneficial than devoting resources to enhance screening (medical or compensational); such screening is unlikely to improve outcomes. The questions of expanded contact, education, and outreach are taken up in Chapter 11.

Regardless of the underlying motivation, screening should be preceded by informed decision making in coordination with a clinician. The reason is that such evaluation has potential benefits and potential harms, and the balance between them may not be clear, especially in RECA-RESEP circumstances. For professional and ethical reasons, an explicit plan for appropriate follow-up services for compensable and noncompensable diseases is needed. Informed decision making is as important, if not more so, for compensational than for medical screening because of the low likelihoods of either monetary payments or health benefits with the former.

COMPENSATIONAL SCREENING ISSUES: THE CORE CONCERN FOR RECA AND RESEP

In compensational screening, individuals being screened may have only a modest likelihood of having a compensable disease. Although the same may be



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