Effects of Direct Care Provision to the Uninsured: Evidence from Federal Breast and Cervical Cancer Programs

Much research has studied the health effects of expanding insurance coverage to low-income people, but there is less work on the direct provision of care to the uninsured. We study the two largest federal programs aimed at reducing breast and cervical cancer among uninsured women in the US: one that paid for cancer screenings with federal funds and one that paid for cancer treatments under state Medicaid programs. Using variation in rollout of each program across states from 1991-2005, we find that funding for cancer treatment did not significantly increase most types of cancer screenings for uninsured women. In contrast, funding for cancer detection significantly increased breast and cervical cancer screenings among 40-64 year old uninsured women, with much smaller effects for insured women (who were not directly eligible). Moreover, we find that these program-induced screenings significantly increased detection of early stage pre-cancers and cancers of the breast but had no significant effect on early stage or other cancers of the cervix. Our results suggest that direct provision can significantly increase healthcare utilization among vulnerable populations.