Research

Targeting services to reduce social inequalities in utilisation: an analysis of breast cancer screening in New South Wales

Stephen Birch^1,2, Marion Haas¹, Elizabeth Savage¹ and Kees Van Gool¹

¹  Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123 Broadway, Sydney, Australia

²  Centre for Health Economics and Policy Analysis, McMaster University, 1200, Main Street West, Hamilton, Ontario L8N 3Z5, Canada

Australia and New Zealand Health Policy 2007, 4:12doi:10.1186/1743-8462-4-12

Published:	5 June 2007

Abstract

Background

Many jurisdictions have used public funding of health care to reduce or remove price at the point of delivery of services. Whilst this reduces an important barrier to accessing care, it does nothing to discriminate between groups considered to have greater or fewer needs. In this paper, we consider whether active targeted recruitment, in addition to offering a 'free' service, is associated with a reduction in social inequalities in self-reported utilization of the breast screening services in NSW, Australia.

Methods

Using the 1997 and 1998 NSW Health Surveys we estimated probit models on the probability of having had a screening mammogram in the last two years for all women aged 40–79. The models examined the relative importance of socio-economic and geographic factors in predicting screening behaviour in three different needs groups – where needs were defined on the basis of a woman's age.

Results

We find that women in higher socio-economic groups are more likely to have been screened than those in lower groups for all age groups. However, the socio-economic effect is significantly less among women who were in the actively targeted age group.

Conclusion

This indicates that recruitment and follow-up was associated with a modest reduction in social inequalities in utilisation although significant income differences remain.