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 the early stage
pre-cancers and cancers of the breast. Our results suggest that direct
provision can significantly increase healthcare utilization among
vulnerable populations.