Does Free Cancer Screening Make a Difference? Evidence from the effects of a free-coupon program in Japan

Since the 1980s, cancer has been the leading cause of death in Japan. The substantial and long-term adverse effects on labor productivity and health expenditures make cancer control an important public health issue. To identify and treat cancer in its early stages, mass cancer screening for target populations is increasingly becoming a common practice. However, cancer screening rates remain low in many areas including Japan. In 2009, a free-coupon program was launched to provide free breast and uterine cancer screening to the target populations. The program further provided free coupons for colorectal cancer screening in 2011. Using rich data from the Comprehensive Survey of Living Conditions (CSLC) in Japan from 2004 to 2019, this study exploits the exogeneous variation in the incentive to receive cancer screening driven by the eligibility for the free-coupon program to analyze: (a) the effects of the program on screening rates and (b) the effects of cancer screening on the physical and mental health of individuals. Our results suggest that providing free coupons significantly increased the probability of attending breast and cervical cancer screenings by approximately 9-10% and that of colorectal cancer screening by approximately 5% for females and 2% for males. Moreover, although young women with low incomes seem to be more likely to use the free coupon for cervical cancer screening, the disadvantaged, such as those with more children and/or old family members in need of care, benefit less from the program. Lastly, we find that receiving cancer screenings could significantly improve individuals’ self-reported health status and reduce the probability of feeling mentally stressed.