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

65 Pages Posted: 12 Aug 2019 Last revised: 5 Jun 2022

See all articles by Marianne P. Bitler

Marianne P. Bitler

University of California, Davis - Departments of Economics and Agricultural Resource Economics; National Bureau of Economic Research (NBER); IZA Institute of Labor Economics

Christopher S. Carpenter

Vanderbilt University; National Bureau of Economic Research (NBER)

Date Written: August 2019

Abstract

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.

Suggested Citation

Bitler, Marianne P. and Carpenter, Christopher S., Effects of Direct Care Provision to the Uninsured: Evidence from Federal Breast and Cervical Cancer Programs (August 2019). NBER Working Paper No. w26140, Available at SSRN: https://ssrn.com/abstract=3435959

Marianne P. Bitler (Contact Author)

University of California, Davis - Departments of Economics and Agricultural Resource Economics ( email )

United States

National Bureau of Economic Research (NBER) ( email )

1050 Massachusetts Avenue
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IZA Institute of Labor Economics

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Christopher S. Carpenter

Vanderbilt University ( email )

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Nashville, TN 37235
United States

HOME PAGE: http://https://sites.google.com/site/kittcarpenter/

National Bureau of Economic Research (NBER)

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