Department of Economics, UC Davis, NBER, and IZA, Davis, CA, USA.
Department of Economics, Vanderbilt University, NBER, and IZA, Nashville, TN, USA.
Health Econ. 2021 Nov;30(11):2667-2685. doi: 10.1002/hec.4397. Epub 2021 Aug 2.
Although colorectal cancer (CRC) screening is highly effective, screening rates lag far below recommended levels, particularly for low-income people. The Colorectal Cancer Control Program (CRCCP) funded $100 million in competitively awarded grants to 25 states from 2009-2015 to increase CRC screening rates among low-income, uninsured populations, in part by directly providing and paying for screening services. Using data from the 2001-2015 Behavioral Risk Factor Surveillance System (BRFSS) and a difference-in-differences strategy, we find no effects of CRCCP on the use of relatively cheap fecal occult blood tests (FOBT). We do, however, find that the CRCCP significantly increased the likelihood that uninsured 50-64-year-olds report ever having a relatively expensive endoscopic CRC screening (sigmoidoscopy or colonoscopy) by 2.9 percentage points, or 10.7%. These effects are larger for women, minorities, and individuals who did not undertake other types of preventive care. We do not find that the CRCCP led to significant changes in CRC cancer detection. Our results indicate that the CRCCP was effective at increasing CRC screening rates among the most vulnerable.
尽管结直肠癌(CRC)筛查非常有效,但筛查率远低于建议水平,尤其是在低收入人群中。CRC 控制计划(CRCCP)在 2009-2015 年期间向 25 个州提供了 1 亿美元的竞争性拨款,以增加低收入、无保险人群的 CRC 筛查率,部分方法是直接提供和支付筛查服务。我们使用了 2001-2015 年行为风险因素监测系统(BRFSS)的数据和差异中的差异策略,发现 CRCCP 对使用相对便宜的粪便潜血试验(FOBT)没有影响。然而,我们发现 CRCCP 显著增加了无保险的 50-64 岁人群报告曾经进行相对昂贵的内镜 CRC 筛查(乙状结肠镜或结肠镜)的可能性,增加了 2.9 个百分点,即 10.7%。这些影响在女性、少数民族和没有进行其他类型预防保健的人群中更大。我们没有发现 CRCCP 导致 CRC 癌症检测的显著变化。我们的结果表明,CRCCP 有效地提高了最脆弱人群的 CRC 筛查率。