Uptake of cancer screening services among middle and older ages in Ireland: the role of healthcare eligibility

Public Health. 2019 Aug;173:42-47. doi: 10.1016/j.puhe.2019.05.025. Epub 2019 Jun 26.


Objectives: The aim of this analysis was to examine the association between public healthcare eligibility combined with private health insurance (PHI) status and the uptake of breast and prostate cancer screening services among middle and older age groups in Ireland.

Study design: This is a cross-sectional analysis using The Irish Longitudinal Study on Ageing (TILDA).

Methods: The analysis included 6902 people aged 50 years and older who completed an in-house interview as part of TILDA. The interview collects information on a range of demographic, socio-economic, health and health service usage variables including the uptake of cancer screening services. An eligibility variable was created using information on public healthcare entitlement and PHI status. The association between eligibility and the uptake of two cancer screening services-mammogram and prostate-specific antigen (PSA) test-was examined using weighted multivariate logistic regression analysis.

Results: The uptake of a mammogram and PSA testing was significantly higher in those with PHI. This relationship held after controlling for a range of confounders including health and socio-economic status.

Conclusions: More research is required to identify the reasons for the higher uptake of cancer screening services among those with PHI, given that insurance does not confer any advantages in accessing these services. It is possible that the higher uptake is explained by differential access to secondary care services between those with and without PHI. Consideration of the integrated nature of healthcare systems is essential when seeking to maximise the uptake of services (such as cancer screening) that potentially involve multiple parts of the healthcare system.

Keywords: Eligibility; Ireland; Mammogram; PSA testing; Private health insurance.

MeSH terms

  • Aged
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / prevention & control
  • Cross-Sectional Studies
  • Early Detection of Cancer / statistics & numerical data*
  • Eligibility Determination
  • Female
  • Health Services / statistics & numerical data*
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Insurance, Health
  • Ireland
  • Longitudinal Studies
  • Male
  • Mammography / statistics & numerical data*
  • Middle Aged
  • Neoplasms / diagnosis*
  • Neoplasms / prevention & control
  • Prostate-Specific Antigen*
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / prevention & control
  • Social Class
  • Socioeconomic Factors


  • Prostate-Specific Antigen