September 2011 Private Health Insurance has Major Impact on Cancer Screening Uptake

A Health Research Board (HRB) funded study carried out by the J. E. Cairnes School of Business and Economics at NUI Galway has found that there are significant differences in cancer screening uptake across income groups, and that the main determinant of this difference for breast, colorectal and prostate cancer screening was the possession of private medical insurance.

According to Brendan Walsh, a HRB/ National Cancer Institute Fellow in Health Economics at NUI Galway: “Our research demonstrates both inequality in the uptake of cancer screening in Ireland, and the role that private health insurance plays in contributing to this.

We examined data on 10,364 adults from the SLÁN 2007 study (Survey of Lifestyle, Attitudes and Nutrition in Ireland) and focused our analysis on the uptake of breast, prostate, colorectal and cervical cancer screening in the previous 12 months.  Through a process called decomposition analysis we were able to unpack the variables that contribute to the levels of inequality that we observed.  Decomposition analysis allows you to establish and rate the importance of particular components which contribute to the overall inequality.  The results of this permit a clearer identification of possible policy actions which can then be taken to help reduce the level of inequality.

The research found that there was a clear link between income and better uptake of screening programmes.  Typically for the four cancers mentioned there was a 10 percentage point difference in uptake rates between the highest socioeconomic group and the lowest.  However for three of those cancers, breast, colorectal and prostrate, medical insurance was the largest factor contributing to the inequality.”

According to Professor Ciaran O’Neill of the J. E. Cairnes School of Business and Economics, a co-author on the paper (along with Dr Mary Silles): “When you have a complex healthcare system as in Ireland, with a mix of public and private services, if people feel that they can access other parts of the service faster because they have private insurance, then they seem more likely to avail of screening services.  Our research seems to indicate that just because you have a publicly funded cancer screening programme, it doesn’t mean that you will see equal uptake of screening services or the end of differences in morbidity or mortality associated with cancer.  Because screening is just the start of a process in the detection, diagnosis and treatment of cancer, the journey should be viewed as a whole and no one part in isolation. Individuals may be more likely to go for screening if they think insurance will afford them faster access to diagnostic or treatment services. Hence publicly funded screening programmes on their own may not eradicate differential health outcomes across income groups.  This finding has major implications for health policy.

The research also highlighted the importance of marital status in several of the cancers. Greater uptake was evident among those who were married than those who were not in the case of prostate, colorectal and cervical screening, perhaps reflecting the value of pester power.”

According to Enda Connolly, Chief Executive at the Health Research Board; “These are very important findings which have the potential to help address health inequalities, here and abroad. It is a clear illustration of the role for research to inform policy for the betterment of society as a whole.”

The full research paper is available at http://onlinelibrary.wiley.com/doi/10.1002/hec.1784/full

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