ArticleFrontiers in public health2026
Cancer screening as a double-edged sword: short-term cost surge and cross-sectional expenditure patterns among urban retirees in Jiangsu, China.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The effectiveness of free cancer screening programs in reducing long-term healthcare expenditures remains debated, yet quasi-experimental evidence is scarce. This study evaluates the impact of a large-scale, government-led free cancer screening program, available to citizens aged 65 and above, on the medical expenditures of urban retirees in Jiangsu Province, China. Methods: We employed a sharp regression discontinuity design (RDD). Our analysis included a cross-sectional sample of 1,503 retired individuals aged 60-70 from Jiangsu Province, China, who participated in free physical examinations in 2021. The treatment group (aged ≥65) was eligible for free cancer screening, while the control group (aged 60-64) was not. The primary outcome was self-reported annual medical expenditure. We estimated local average treatment effects using local linear regression with a triangular kernel and conducted robustness checks using alternative bandwidths and polynomial orders. Results: A significant discontinuity in annual medical expenditure was observed at the eligibility threshold. The free screening policy led to an immediate increase in medical spending at age 65 (RD estimate = CNY 1968, 95% CI [1,042, 2,894], *p* < 0.001). This short-term surge (ages 65-67) was primarily driven by increased health information-seeking and subsequent medical consultations. Cross-sectional trend analysis revealed different expenditure patterns across age cohorts, with those aged 68 and above showing slower growth rates in medical spending compared to younger cohorts. Subgroup analyses indicated that the policy's impact was more pronounced among men and residents of developed regions. Conclusion: Free cancer screening acts as a double-edged sword for medical expenditures among older adults. It induces a short-term cost surge likely due to initial information shock and elevated risk perception. Policymakers should anticipate and manage the initial demand shock while considering the differentiated patterns across age groups. Strategies to optimize information delivery and mitigate gender and regional disparities are crucial for enhancing the equity and cost-effectiveness of such large-scale preventive health programs.
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