Does free cancer screening make a difference? Evidence from the effects of a free-coupon program in Japan

Cancer risk increases with age rapidly after midlife. One of the serious consequences of population aging is the substantial adverse effect of cancer on labor productivity and health expenditures. To address this issue, mass cancer screening for target population is increasingly becoming a common practice. However, cancer screening rates remain low in many areas, and there is a lack of comprehensive understanding of the mental health effects of cancer screening. In 2009, a national free-coupon program was launched in Japan to provide free breast and cervical cancer screenings to the target population. The program further provided a voucher for a free colorectal cancer screening in 2011. Using rich data from the Comprehensive Survey of Living Conditions in Japan from 2007 to 2013, this study exploits the exogenous variation in the incentive to receive cancer screening driven by the program to analyze: (a) the effects of the program on screening uptake and (b) the effects of cancer screening on mental health, self-reported symptoms, and smoking behavior. Our results suggest that the program significantly increased the probability of attending breast and cervical cancer screenings by approximately 9–10% and that of attending colorectal cancer screening by approximately 6% for female and 3% for male. Cancer screening appears to have some heterogeneous effects on mental health and smoking behavior, but the estimates are generally weak and/or inconsistent.