Has the National Cancer Screening Program reduced income inequalities in screening attendance in South Korea?
OBJECTIVE
In 1999, the Korean government introduced the National Cancer Screening Program (NCSP) to increase the cancer-screening rate, particularly among the low-income population. This study investigates how the NCSP has decreased both relative and absolute income inequalities in the uptake of cancer screening in South Korea.


METHODS
A nationally representative cross-sectional repeated data from the Korea National Health and Nutrition Examination Survey 1998-2012, managed by the Ministry of Health and Welfare, was used to assess changes over time and the extent of discontinuity at the NCSP-recommended initiation age in the uptake of screening for breast, colorectal, and gastric cancers across income quartiles.


RESULTS
Relative inequalities in the uptake of screening for all cancers decreased significantly over the policy period. Absolute inequalities did not change for most cancers, but marginally increased from 9 to 14% points in the uptake of screening for colorectal cancer among men. At the recommended initiation age, absolute inequalities did not change for breast and colorectal cancers but increased from 5 to 16% points for gastric cancer, for which relative inequality significantly decreased.


CONCLUSIONS
The NCSP, which reduced out-of-pocket payment, may not decrease absolute gap although it leads to overall increases in the uptake of cancer screening and decreases in relative inequalities. Further investigations are needed to understand barriers that prevent the low-income population from attending cancer screening.
Takemi Program in International Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA. sujin0818@gmail.com.
Sujin
S
Kim
Department of Health Policy and Management, School of Public Health, Seoul National University, Seoul, South Korea.
Soonman
S
Kwon
Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
S V
SV
Subramanian
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D010342:Patient Acceptance of Health Care; D056910:Republic of Korea / Q000453:epidemiology; D012959:Socioeconomic Factors; D013274:Stomach Neoplasms / Q000175:diagnosis*
Cancer; Inequality; Screening attendance; South Korea