When public health intervention is not successful: Cost sharing, crowd-out, and selection in Korea's National Cancer Screening Program.
This study investigates the impact of and behavioral responses to cost sharing in Korea's National Cancer Screening Program, which provides free stomach and breast cancer screenings to those with an income below a certain cutoff. Free cancer screening substantially increases the screening take up rate, yielding more cancer detections. However, the increase in cancer detection is quickly crowded out by cancer detection through other channels such as diagnostic testing and private cancer screening. Further, compliers are much less likely to have cancer than never takers. Crowd-out and selection help explain why the program has been unable to reduce cancer mortality.
Department of Policy Analysis and Management, Cornell University, Ithaca, NY 14853, United States. Electronic address: hk788@cornell.edu.
Hyuncheol Bryant
HB
Kim
National Health Insurance System (NHIS), Seoul, Republic of Korea. Electronic address: lsm8711@nhis.or.kr.
Sun-Mi
SM
Lee
D002423:Cause of Death / Q000639:trends; D017047:Cost Sharing; D055088:Early Detection of Cancer / Q000191:economics* / Q000592:standards / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D009369:Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation; D015980:Public Health Practice / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D012044:Regression Analysis; D056910:Republic of Korea
Cancer screening; Cost sharing; Crowd-out; H40; I10; Public health intervention; Selection