Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program (2005) / Chapter Skim
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10 Screening for Compensation
10 Screening for Compensation
Pages 257-273
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From page 257... ...
to facilitate the RECA compensation program. Chapter 9 clarified that screening activities have two purposes and targets: medical screening to improve health outcomes and compensational screening specifically for RECA.
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From page 258... ...
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)
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From page 259... ...
will certainly be near the limits of the ability of some persons to make wellconsidered decisions. The even more complex tradeoffs in compensational screening (for example, balancing medical risks against the sometimes small likelihood of monetary gain)
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From page 260... ...
The other is a highly prevalent, serious condition in some RECA populations: type 2 diabetes. Lung cancer is the only RECA disease that is compensable in all five RECA populations (miners, millers, ore transporters, onsite participants, and downwinders)
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From page 261... ...
The problem of the cascade of false positives, discussed in Chapter 9 as an important issue in medical screening, would disappear, at least with respect to compensational screening. However, the patient would still face the cascade of medical false-positives results and the medical risks they engender, perhaps without medical benefit.
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From page 262... ...
value might be regarded as unusually precise. If, as in the policies and procedures for the Energy Employees Occupational Illness Compensation Program Act (EEOICPA)
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From page 263... ...
. Unlike REVCA, under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA)
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From page 264... ...
Nonetheless, if patients were to choose to set aside the issue of costs and the risks of medical, social, and psychologic consequences of false-positive results, they might request to have a "RECA whole-body MRI." An MRI would not expose the person screened to ionizing radiation. Moreover, it could be considered a gold standard for establishing the presence of RECA-compensable disease insofar as it produces information relevant to the body parts that any RECAcompensable disease might affect, albeit at enormous cost in terms of falsepositive results.
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From page 265... ...
Because each of the screening tests except a postmortem examination places the patient at risk for a false-positive finding or even at risk for a true-positive result that identifies a disease that does not benefit from early intervention, such compensational screening creates some degree of medical risk. The risk may be physical or psychologic (or both)
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From page 266... ...
One part of appropriate counseling about compensational screening might be to use a decision-support tool that helps patients to understand their willingness to risk health consequences in exchange for the opportunity for monetary gain. Willingness to risk is, in effect, the obverse of one's willingness to pay for healthy life years -- a concept and measurement method with decades of theory and application (Gold et al., 1996, p28)
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From page 267... ...
SCREENING FOR COMPENSATION 267 mends that RESEP screening be undertaken only if individuals satisfy administrative criteria for compensation before screening. By satisfying administrative criteria, we mean that patients need to be certain that they are already administratively eligible before any screening takes place.
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From page 268... ...
Clearly, a RECA compensational screening program could look for the presence of any or all of the RECA-compensable diseases. Which tests or combinations of tests to perform should involve the patient's informed consent about risks and the often-small likelihood of benefits (primarily from compensation)
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From page 269... ...
The burden of a false-positive test, however, will be the physical, psychologic, and social risks described in Chapter 9. A more difficult question -- which may not even be practical to address -- is whether the criterion of positivity of a medical screening test should be adjusted to reflect the individually calculated value of PC/AS or its uncertainty.
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From page 270... ...
Thus, the committee recommends that the Department of Health and Human Services support development of explicit decision models and approaches to shared decision making and related tools that enhance the ability of patients to participate in decisions that affect their care and prognosis. We recommend, in particular, that HRSA take responsibility for similar activities in the domain of compensational screening.
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From page 271... ...
HEALTH-CARE ISSUES BEYOND SCREENING Followup Diagnostic and Therapeutic Services One question that arises for of any medical screening situation and presumably for RECA and RESEP even for compensational screening concerns the obligations to patients inherent in the programs themselves and in the agency roles of health care providers. When applicants or patients are found, through RESEP screening, to be at special risk for a particular RECA-compensable condition, the expectation (and apparently generally the practice)
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From page 272... ...
Other populations covered by radiation-compensation programs (REVCA and EEIOCPA) provide medical services; uranium workers covered under RECA are also covered under EEIOCPA for medical expenses.
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From page 273... ...
The next chapter addresses on the remaining core elements of the RESEP program: education and outreach.
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