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When public health intervention is not successful: Cost sharing, crowd-out, and selection in Korea's National Cancer Screening Program

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  • Kim, Hyuncheol Bryant
  • Lee, Sun-mi

Abstract

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.

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  • Kim, Hyuncheol Bryant & Lee, Sun-mi, 2017. "When public health intervention is not successful: Cost sharing, crowd-out, and selection in Korea's National Cancer Screening Program," Journal of Health Economics, Elsevier, vol. 53(C), pages 100-116.
    • Handle: RePEc:eee:jhecon:v:53:y:2017:i:c:p:100-116
    DOI: 10.1016/j.jhealeco.2017.02.006
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    Cited by:

    1. Rebecca Mary Myerson & Darius Lakdawalla & Lisandro D. Colantonio & Monika Safford & David Meltzer, 2018. "Effects of Expanding Health Screening on Treatment - What Should We Expect? What Can We Learn?," NBER Working Papers 24347, National Bureau of Economic Research, Inc.
    2. Norman Bannenberg & Oddvar Førland & Tor Iversen & Martin Karlsson & Henning Øien, 2021. "Preventive Home Visits," American Journal of Health Economics, University of Chicago Press, vol. 7(4), pages 457-496.
    3. Guthmuller, Sophie & Carrieri, Vincenzo & Wübker, Ansgar, 2023. "Effects of organized screening programs on breast cancer screening, incidence, and mortality in Europe," Journal of Health Economics, Elsevier, vol. 92(C).
    4. Patrick Opoku Asuming & Hyuncheol Bryant Kim & Armand Sim, 2024. "Selection and behavioral responses of health insurance subsidies in the long run: Evidence from a field experiment in Ghana," Health Economics, John Wiley & Sons, Ltd., vol. 33(5), pages 992-1032, May.
    5. Kim, Hyuncheol Bryant & Lee, Suejin & Lim, Wilfredo, 2017. "Knowing Is Not Half the Battle: Impacts of the National Health Screening Program in Korea," IZA Discussion Papers 10650, Institute of Labor Economics (IZA).
    6. Amanda E Kowalski, 2023. "Behaviour within a Clinical Trial and Implications for Mammography Guidelines," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 90(1), pages 432-462.
    7. Asuming, Patrick Opoku & Kim, Hyuncheol Bryant & Sim, Armand, 2017. "Long-Run Consequences of Health Insurance Promotion: Evidence from a Field Experiment in Ghana," IZA Discussion Papers 11117, Institute of Labor Economics (IZA).
    8. ZHAO Meng (KONISHI Moe), 2023. "Does Free Cancer Screening Make a Difference? Evidence from the effects of a free-coupon program in Japan," Discussion papers 23067, Research Institute of Economy, Trade and Industry (RIETI).
    9. Patrick Opoku Asuming & Hyuncheol Bryant Kim & Armand Sim, 2021. "Selection and Behavioral Responses of Health Insurance Subsidies in the Long Run: Evidence from a Field Experiment in Ghana," Papers 2105.00617, arXiv.org.
    10. Patrick Asuming & Hyuncheol Bryant Kim & Armand Sim, 2018. "Long-run Consequences of Health Insurance Promotion When Mandates are Not Enforceable: Evidence from a Field Experiment in Ghana," Papers 1811.09004, arXiv.org, revised Jun 2019.
    11. Abbasi, Ali & DiTraglia, Francis J. & Gazze, Ludovica & Pals, Bridget, 2023. "Hidden hazards and screening policy: Predicting undetected lead exposure in Illinois," Journal of Health Economics, Elsevier, vol. 90(C).
    12. Hwang, Jisoo & Hwang, Seung-sik & Kim, Hyuncheol Bryant & Lee, Jungmin & Lee, Junseok, 2023. "Risk Compensation after COVID-19 Vaccination," IZA Discussion Papers 16053, Institute of Labor Economics (IZA).
    13. Rebecca Myerson & Darius Lakdawalla & Lisandro D. Colantonio & Monika Safford & David Meltzer, 2018. "Effects of expanding health screening on treatment – What should we expect? What can we learn?," Working Papers 2018-014, Human Capital and Economic Opportunity Working Group.
    14. Moran, Patrick & Cullinan, John, 2022. "Is mammography screening an effective public health intervention? Evidence from a natural experiment," Social Science & Medicine, Elsevier, vol. 305(C).
    15. Jisoo Hwang & Seung‐sik Hwang & Hyuncheol Bryant Kim & Jungmin Lee & Junseok Lee, 2024. "Risk compensation after COVID‐19 vaccination: Evidence from vaccine rollout by exact birth date in South Korea," Health Economics, John Wiley & Sons, Ltd., vol. 33(8), pages 1811-1830, August.

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    More about this item

    Keywords

    I10; H40; Public health intervention; Cost sharing; Crowd-out; Selection; Cancer screening;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • H40 - Public Economics - - Publicly Provided Goods - - - General

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