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.
