Forgone Health and Economic Benefits Associated with Socioeconomic Differences in Organized Cervical Cancer Screening

Document Type : Research Articles


1 Department of Health Services Administration, China Medical University, Taichung, Taiwan.

2 Department of Family Medicine, E-Da Hospital, Kaohsiung, Taiwan.

3 Department of Nursing, China Medical University Hospital, Taichung, Taiwan.

4 Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.

5 Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan.

6 Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

7 School of Medicine, National Yang-Ming University, Taipei, Taiwan.


Objective: To describe cervical cancer screening participation among women in Taiwan under its population-based screening policy and to estimate the economic burden of disease attributable to avoidable disparities in cervical cancer (CC) screening. Methods: We identified a nationally-representative sample of females aged 30 years or above who were eligible for Pap smear testing in Taiwan from 1 January to 31 December 2013. An administrative database with detailed claims of health care utilization under the universal coverage health care system was used. Socioeconomic position of the female subjects was defined using the occupation classification, and two groups were specifically identified: general (O1) and low-income (O5) groups. Differences in screening rate, CC prevalence, and CC-attributable deaths were assessed between the two groups. Economic consequences as a result of screening inequalities were estimated using actual total health care spending (health care expenditure), monetary value per life-year and years of life lost for ill health and screening disparities (health as consumption good), and productivity losses alongside costs of social benefits (health as capital good). Result: A total of 301,057 enrolled females aged 30 years and older eligible for screening were identified. Overall, 3-year and 1-year screening rates among all subjects were 0.601 and 0.372, respectively. Impact of observed differences in screening translated to US$59,568 of health care spending in one year, 90.4% of which was specific to hospital admissions. When we viewed health as a consumption good and capital good, the impact of screening disparity on health losses through CC would be equivalent to US$78,095 and US$190,868, respectively. Conclusion: Forgone health and economic benefits associated with inequalities in CC screening uptake can be considerable in productive women.