In India, non-communicable diseases account for over 60% of all deaths, with cancer as a leading cause. Early detection through breast and cervical cancer screenings remains limited, particularly among low-income populations. This study examines whether a publicly funded health insurance program increased access to preventive screenings. Using administrative data on program rollout and the 2015–16 National Family Health Survey, we apply an instrumental variable approach. We find that insurance coverage significantly increases reported screenings. These results suggest that subsidized health insurance can improve early diagnosis and access to preventive care in resource-constrained settings such as Asia and Africa.
AkinyemijuTOgunsinaKSakhujaS, et al. (2016) Life-course socioeconomic status and breast and cervical cancer screening: analysis of the WHO’s study on global ageing and adult health (SAGE). BMJ Open6(11): e012753.
4.
AzamM (2018) Does social health insurance reduce financial burden? Panel data evidence from India. World Development102: 1–17.
5.
CedoliniCBertozziSLonderoAP, et al. (2014) Type of breast cancer diagnosis, screening, and survival. Clinical Breast Cancer14(4): 235–240.
6.
DasJLeinoJ (2011) Evaluating the RSBY: lessons from an experimental information campaign. Economic and Political Weekly46: 85–93.
7.
DugganCTrapaniDIlbawiAM, et al. (2021) National health system characteristics, breast cancer stage at diagnosis, and breast cancer mortality: a population-based analysis. The Lancet Oncology22(11): 1632–1642.
8.
EckertL (2024) Enough: Because We Can Stop Cervical Cancer. Cambridge: Cambridge University Press.
9.
GuptaRGuptaSMehrotraR, et al. (2020) Risk factors of breast cancer and breast self-examination in early detection: systematic review of awareness among Indian women in community and health care professionals. Journal of Public Health42(1): 118–131.
10.
KaranASelvarajSMahalA (2014) Moving to universal coverage? Trends in the burden of out-of-pocket payments for health care across social groups in India, 1999–2000 to 2011–12. PLoS ONE9(8): e105162.
11.
KaranAYipWMahalA (2017) Extending health insurance to the poor in India: an impact evaluation of Rashtriya Swasthya Bima Yojana on out of pocket spending for healthcare. Social Science & Medicine18: 183–192.
12.
KremerMGlennersterR (2011) Improving health in developing countries: evidence from randomized evaluations. In: PaulyMVMcGuireTGBarrosPP (eds) Handbook of Health Economics, Vol. 2. Amsterdam: Elsevier, pp.201–315.
13.
MalaniAHoltzmanPImaiK, et al. (2021) Effect of health insurance in India: A randomized controlled trial (No. w29576). National Bureau of Economic Research. Cambridge, MA.
14.
MalviaSBagadiSADubeyUS, et al. (2017) Epidemiology of breast cancer in Indian women. Asia-Pacific Journal of Clinical Oncology13(4): 289–295.
15.
MishraGAPimpleSAShastriSS (2011) An overview of prevention and early detection of cervical cancers. Indian Journal of Medical and Paediatric Oncology32(03): 125–132.
16.
MohantySKWadasadawalaTSenS, et al. (2023) Socio-economic variations of breast cancer treatment and discontinuation: a study from a public tertiary cancer hospital in Mumbai, India. BMC Women’s Health23(1): 113.
17.
MozumdarAAruldasKJainA, et al. (2018) Understanding the use of India’s National Health Insurance Scheme for family planning and reproductive health services in Uttar Pradesh. The International Journal of Health Planning and Management33(4): 823–835.
18.
NandiAAshokALaxminarayanR (2013) The socioeconomic and institutional determinants of participation in India’s Health Insurance Scheme for the poor. PLoS ONE9(1): e8666296.
19.
NegiJNambiarD (2021) Intersectional social-economic inequalities in breast cancer screening in India: analysis of the National Family Health Survey. BMC Women’s Health21: 1–9.
20.
PalaciosRJDasJSunW (2011) India’s Health Insurance Scheme for the Poor: Evidence from the Early Experience of the Rashtriya Swasthya Bima Yojana. New Delhi, India: Centre for Policy Research.
21.
PatilPSarangBBhandarkarP, et al. (2023) Does women’s empowerment and their socioeconomic condition affect the uptake of breast cancer screening? Findings from NFHS-5, India. BMC Women’s Health23(1): 1–8.
22.
PuriRSunC (2021) Increasing utilization of public health insurance programs: evidence from an experiment in India. World Development139: 105321.
23.
RajasekharDBergEGhatakM, et al. (2011) Implementing health insurance: the rollout of Rashtriya Swasthya Bima Yojana in Karnataka. Economic and Political Weekly2011: 56–63.
24.
RaviSBergkvistS (2014) Are publicly financed health insurance schemes working in India. National Council of Applied Economic Research11(1): 158–192.
25.
ReichheldAMukherjeePKRahmanSM, et al. (2020) Prevalence of cervical cancer screening and awareness among women in an urban community in South India: a cross sectional study. Annals of Global Health86(1): 30.
26.
SaxenaUSauvagetCSankaranarayananR (2012) Evidence-based screening, early diagnosis and treatment strategy of cervical cancer for national policy in low-resource countries: example of India. Asian Pacific Journal of Cancer Prevention13(4): 1699–1703.
27.
SiddharthRGuptaDNarangR, et al. (2016) Knowledge, attitude and practice about breast cancer and breast self-examination among women seeking out-patient care in a teaching hospital in Central India. Indian Journal of Cancer53(2): 226–229.
28.
SofiNYJainMKapilU, et al. (2019) Epidemiological characteristics of breast cancer patients attending a tertiary health-care institute in the National Capital Territory of India. Journal of Cancer Research and Therapeutics15(5): 1087–1091.
29.
SomdattaPBaridalyneN (2008) Awareness of breast cancer in women of an urban resettlement colony. Indian Journal of Cancer45(4): 149–153.
30.
SriramSKhanMM (2020) Effect of health insurance program for the poor on out-of-pocket in-patient care cost in India: evidence from a nationally representative cross-sectional survey. BMC Health Services Research20(1) 1–21.
31.
ThulaseedharanJVMalilaNHakamaM, et al. (2013) Effect of screening on the risk estimates of socio demographic factors on cervical cancer: a large cohort study from rural India. Asian Pacific Journal of Cancer Prevention14(1): 589–594.
32.
VirkAAtunR (2015) Towards universal health coverage in India: a historical examination of the genesis of Rashtriya Swasthya Bima Yojana: the Health Insurance Scheme for low-income groups. Public Health129(6): 810–817.
