An economic examination of cancer screening
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A substantial burden is borne by individuals and societies from cancer. Cancer control strategies are implemented to reduce this burden and cancer screening is a central facet within cancer control strategies. Cancer screening allows for the earlier detection of a cancer, affording quicker access to treatment thereby reducing morbidity and mortality from the disease. Due to the pertinence of screening in reducing the burden of cancer it is important to understand why individuals decide to screen. Within this context, this thesis explores variations in screening utilisation across socio-demographic groups and seeks to understand why these variations arise. The analyses in this thesis are located within an expected utility framework, whereby an individual will screen if the utility elicited from screening is larger than not screening. Socioeconomic variables such as education, social class, income, marital status and insurance status can each impact upon the net expected benefit of screening, resulting in socioeconomic differences in screening utilisation. In this thesis an emphasis is placed upon measuring socioeconomic inequalities. Concentration indices, along with regression analyses, are employed to measure inequalities and both of these methods allow for inequalities to be readily compared across various populations in a consistent and systematic fashion. Furthermore, individuals' decisions to engage with screening is dependent upon the organisation of screening (opportunistic or population-based) that exists. A greater burden is borne by individuals, especially those in lower socioeconomic groups, within an opportunistic programme in terms of acquiring information about the screen, organising the screen and accruing greater pecuniary and non-pecuniary costs. In this sense, this thesis explores differential patterns of screening across demographic groups between opportunistic and population-based programmes. This thesis explores these differential patterns of utilisation in an international setting using nationally representative surveys across the island of Ireland, Europe, the UK and the US. This thesis highlights that variations in cancer screening across socio-demographic groups exist. As socioeconomic variables are amongst the largest determinants of utilisation, variations in utilisation across socioeconomic groups are observed, and these variations differ according to the screening programme that exists. The implementation of population-based programmes reduces socioeconomic inequalities in utilisation. However, if health insurance affords quicker access to screening or treatment or distinct groups exist within a population, a more nuanced approach to addressing inequalities may be needed by policymakers.
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