The role of private medical insurance in socio-economic inequalities in cancer screening uptake in Ireland.

Screening is seen by many as a key element in cancer control strategies. Differences in uptake of screening related to socio-economic status exist and may contribute to differences in morbidity and mortality across socio-economic groups. Although a number of factors are likely to underlie differential uptake, differential access to subsequent diagnostic tests and/or treatment may have a pivotal role. This study examines differences in the uptake of cancer screening in Ireland related to socio-economic status. Data were extracted from SLÁN 2007 concerning uptake of breast, cervical, colorectal and prostate cancer screening in the preceding 12 months. Concentration indices were calculated and decomposed. Particular emphasis was placed in the decomposition upon the impact of private health insurance, evidenced in other work to impact on access to care within the mixed public-private Irish health system. This study found that significant differences related to socio-economic status exist with respect to uptake of cancer screening and that the main determinant of difference for breast, colorectal and prostate cancer screening was possession of private insurance. This may have profound implications for the design of cancer control strategies in countries where private insurance has a significant role, even where screening services are publicly funded and population based.

The importance of socio-economic variables in cancer screening participation: a comparison between population-based and opportunistic screening in the EU-15.

OBJECTIVES: To investigate differences in participation with breast and cervical cancer screening related to individual socio-economic characteristics, across population-based versus opportunistic screening programmes. METHODS: Data from Eurobarometer 66.2 "Health in the European Union" 2006 on self-reported breast and cervical cancer screening participation in the preceding 12 months within the EU 15 was obtained The sample was restricted to those eligible for screening based on the screening age within each country. Observations for 2214 and 5025 individuals respectively for breast and cervical cancer screening were available. Data on marital status, self-reported health, socio-economic group and years of education were also available. Screening programmes were categorised as population-based or opportunistic and logistic regression analysis used to examine the relationship between participation, individual characteristics and programme type. RESULTS: Differences in participation related to socio-economic status were observed in opportunistic screening programmes for breast cancer (OR=0.63* and OR=0.51**) and cervical cancer (OR=0.75** and OR=0.64**). Differences related to socio-economic characteristics were not found with respect to participation in population-based programmes. CONCLUSIONS: In opportunistic programmes, differences in participation across socio-economic groups are evident in respect of both breast and cervical cancer screening. These differences may have implications for treatment and outcomes across socio-economic groups. Such differences were not evident in population-based programmes.