{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:47:49Z","timestamp":1782366469466,"version":"3.54.5"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We employed a sharp regression discontinuity design (RDD). Our analysis included a cross-sectional sample of 1,503 retired individuals aged 60\u201370 from Jiangsu Province, China, who participated in free physical examinations in 2021. The treatment group (aged \u226565) was eligible for free cancer screening, while the control group (aged 60\u201364) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u202f=\u202fCNY 1968, 95% CI [1,042, 2,894], *p*\u202f&amp;lt;\u202f0.001). This short-term surge (ages 65\u201367) 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\u2019s impact was more pronounced among men and residents of developed regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1822162","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:29:36Z","timestamp":1782365376000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cancer screening as a double-edged sword: short-term cost surge and cross-sectional expenditure patterns among urban retirees in Jiangsu, China"],"prefix":"10.3389","volume":"14","author":[{"given":"Sha","family":"Liu","sequence":"first","affiliation":[{"name":"School of Public Administration, Hohai University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Government, Nanjing University","place":["Nanjing, China"]},{"name":"Think Tank of Ageing-Responsive Civilization","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"102047","DOI":"10.1016\/j.chieco.2023.102047","article-title":"Internet access and older adults' health: evidence from China","volume":"82","author":"Ding","year":"2023","journal-title":"China Econ Rev"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"144","DOI":"10.19744\/j.cnki.11-1235\/f.2023.0150","article-title":"The superior doctor prevents diseases: the impact of free physical examination programs on medical services and health welfare of the elderly","volume":"39","author":"Ma","year":"2023","journal-title":"Manage World"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1111\/j.1365-2524.2012.01079.x","article-title":"Introducing mental health and substance use screening into a community-based health service in Australia: usefulness and implications for service change","volume":"20","author":"Thomas","year":"2012","journal-title":"Health Soc Care Community"},{"key":"ref4","first-page":"1176","article-title":"Gender differences in elder's participation in the national cancer screening program: evidence from Korean National Health and nutrition examination survey 2010-12","volume":"44","author":"Kim","year":"2010","journal-title":"Iran J Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"CD010411","DOI":"10.1002\/14651858.CD010411.pub2","article-title":"Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease","volume":"2018","author":"Dyakova","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"ref6","first-page":"14","article-title":"Estimating true burden of disease detected by screening tests of varying validity","volume":"45","author":"Mishra","year":"2001","journal-title":"Indian J Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"820750","DOI":"10.3389\/fpubh.2022.820750","article-title":"Cost-effectiveness of population screening programs for cardiovascular diseases and diabetes in low- and middle-income countries: a systematic review","volume":"10","author":"Sharma","year":"2022","journal-title":"Front Public Health"},{"key":"ref8","first-page":"583","article-title":"The utilization of health care by the elderly with chronic health problems in Kaohsiung City","volume":"10","author":"Chiou","year":"1994","journal-title":"Gaoxiong yi xue ke xue za zhi"},{"key":"ref9","first-page":"378","article-title":"Coping behaviors of the elderly with positive physical examination results in Kaohsiung City","volume":"13","author":"Guo","year":"1997","journal-title":"Kaohsiung J Med Sci"},{"key":"ref10","first-page":"81","article-title":"A survey on the participation of the elderly aged 65 and above in free health check-ups in Hengqin","volume":"36","author":"Zhang","year":"2023","journal-title":"Med Inf"},{"key":"ref11","first-page":"2591","author":"Li","year":"2017"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1007\/s10433-013-0280-x","article-title":"The effect of population aging on health expenditure growth: a critical review","volume":"10","author":"de Meijer","year":"2013","journal-title":"Eur J Ageing"},{"key":"ref13","first-page":"1","article-title":"Expenditure on medical care and ratio of medical care spending to consumption expenditure in elderly households","volume":"25","author":"Yang","year":"2007","journal-title":"J Korean Home Manag Assoc"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.11847\/zgggws1115516","article-title":"Medical expenditure and health insurance utilization among middle-aged and elderly residents in Shanxi province","volume":"34","author":"Jiang","year":"2018","journal-title":"China J Public Health"},{"key":"ref15","first-page":"513","article-title":"Study on the influencing factors of the medical expenses of the elderly using the semi-parametric quantile regression model","volume":"39","author":"Li","year":"2022","journal-title":"Chin J Health Stat"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1639687","DOI":"10.3389\/fpubh.2025.1639687","article-title":"Who determines nasopharyngeal carcinoma inpatients' medical expenditure? Importance factor ranking using the random forest model","volume":"13","author":"Zhu","year":"2025","journal-title":"Front Public Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1186\/s13023-020-01423-7","article-title":"Medical expenditure for patients with hemophilia in urban China: data from medical insurance information system from 2013 to 2015","volume":"15","author":"Gong","year":"2020","journal-title":"Orphanet J Rare Dis"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/1475-9276-13-4","article-title":"Changes in the magnitude of social inequality in the uptake of cervical cancer screening in Taiwan, a country implementing a population-based organized screening program","volume":"13","author":"Chiou","year":"2014","journal-title":"Int J Equity Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1002\/ijgo.14158","article-title":"Determinants of cervical cancer screening uptake among women with access to free screening: a community-based study in peri-urban Ghana","volume":"159","author":"Tawiah","year":"2022","journal-title":"Int J Gynaecol Obstet"},{"key":"ref20","first-page":"209","article-title":"Survey on the current status of physical examination of the rural elderly in Anqing","volume":"19","author":"Li","year":"2018","journal-title":"China Prev Med"},{"key":"ref21","first-page":"8","article-title":"Analysis of breast and cervical cancer screening rates and related influencing factors among women in Guangdong Province","volume":"36","author":"Meng","year":"2010","journal-title":"South China J Prev Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"186837","DOI":"10.1371\/journal.pone.0186837","article-title":"An equity analysis of health examination service utilization by women from underdeveloped areas in western China","volume":"12","author":"Qian","year":"2017","journal-title":"PLoS One"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1177\/0002764209338800","article-title":"The mandate of heaven and performance legitimation in historical and contemporary China","volume":"53","author":"Zhao","year":"2009","journal-title":"Am Behav Sci"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1177\/0010414019897698","article-title":"Building credibility and cooperation in low-trust settings: persuasion and source accountability in Liberia during the 2014-2015 Ebola crisis","volume":"53","author":"Tsai","year":"2020","journal-title":"Comp Polit Stud"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1177\/0952076713518339","article-title":"What happens on the ground: persistent issues in implementation research","volume":"29","author":"Hupe","year":"2014","journal-title":"Public Policy Adm"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1146\/annurev-polisci-012610-135202","article-title":"Policy makes mass politics","volume":"15","author":"Campbell","year":"2012","journal-title":"Annual Rev. Polit. Sci."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1111\/psj.12340","article-title":"Varieties of policy feedback research: looking backward, moving forward","volume":"47","author":"B\u00e9land","year":"2019","journal-title":"Policy Stud J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1017\/S1537592717004182","article-title":"When and how new policy creates new politics: examining the feedback effects of the affordable care act on public opinion","volume":"16","author":"Jacobs","year":"2018","journal-title":"Perspect Polit"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1017\/S1537592704000623","article-title":"The consequences of public policy for democratic citizenship: bridging policy studies and mass politics","volume":"2","author":"Mettler","year":"2004","journal-title":"Perspect Polit"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1111\/psj.12042","article-title":"Learning from schools: school choice, political learning, and policy feedback","volume":"42","author":"Fleming","year":"2014","journal-title":"Policy Stud J"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1080\/13876988.2020.1780126","article-title":"Attitudinal feedback towards sub-national social policy: a comparison of popular support for social health Insurance in Urban China","volume":"23","author":"He","year":"2021","journal-title":"J Comp Policy Anal"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1093\/jopart\/mus048","article-title":"Effects of transparency on the perceived trustworthiness of a government organization: evidence from an online experiment","volume":"24","author":"Grimmelikhuijsen","year":"2014","journal-title":"J Public Adm Res Theory"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.2139\/ssrn.2601356","article-title":"Too much transparency? How critics of openness misunderstand administrative development","author":"Roberts","year":"2015","journal-title":"SSRN Electron J"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"103","DOI":"10.4324\/9780429494284-4","article-title":"Policy feedback theory","author":"Mettler","year":"2018","journal-title":"Polit. Sci. Econ."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1177\/0020852311429667","article-title":"Linking transparency, knowledge and citizen trust in government: an experiment","volume":"78","author":"Grimmelikhuijsen","year":"2012","journal-title":"Int Rev Adm Sci"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2202\/1944-2866.1076","article-title":"The trouble with transparency: a critical review of openness in e-government","volume":"3","author":"Bannister","year":"2011","journal-title":"Policy Internet"},{"key":"ref37","doi-asserted-by":"crossref","DOI":"10.5871\/bacad\/9780197263839.001.0001","volume-title":"Transparency: The Key to Better Governance?","author":"Hood","year":"2006"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1162\/isec_a_00336","article-title":"Bad world: the negativity bias in international politics","volume":"43","author":"Johnson","year":"2018","journal-title":"Int Secur"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1207\/S15327957PSPR0504_2","article-title":"Negativity bias, negativity dominance, and contagion","volume":"5","author":"Rozin","year":"2001","journal-title":"Personal Soc Psychol Rev"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"595","DOI":"10.2307\/2950710","article-title":"When effect becomes cause: policy feedback and political change","volume":"45","author":"Pierson","year":"1993","journal-title":"World Polit"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1086\/689286","article-title":"Personal experience and public opinion: a theory and test of conditional policy feedback","volume":"79","author":"Lerman","year":"2017","journal-title":"J Polit"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1215\/03616878-26-5-851","article-title":"Uncertainty and the welfare economics of medical care","volume":"26","author":"Arrow","year":"2001","journal-title":"J Health Polit Policy Law"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1086\/259880","article-title":"On the concept of health capital and the demand for health","volume":"80","author":"Grossman","year":"1972","journal-title":"J Polit Econ"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"61","DOI":"10.2307\/2534582","article-title":"The buffer-stock theory of saving: some macroeconomic evidence","volume":"1992","author":"Carroll","year":"1992","journal-title":"Brook Pap Econ Act"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"3345","DOI":"10.1257\/aer.20230521","article-title":"Women left behind: gender disparities in utilization of government health insurance in India","volume":"114","author":"Dupas","year":"2024","journal-title":"Am Econ Rev"},{"key":"ref46","doi-asserted-by":"crossref","DOI":"10.1525\/9780520916623","volume-title":"Encounters with Aging: Mythologies of Menopause in Japan and North America","author":"Lock","year":"1994"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"e282","DOI":"10.1016\/S2468-2667(24)00053-7","article-title":"Differences across the lifespan between females and males in the top 20 causes of disease burden globally: a systematic analysis of the global burden of disease study 2021","volume":"9","author":"Patwardhan","year":"2021","journal-title":"Lancet Public Health"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"2137","DOI":"10.3390\/healthcare12212137","article-title":"Exploring the relationship between health and out-of-pocket health expenditures: evidence for middle-aged and older adults in China","volume":"12","author":"Gao","year":"2024","journal-title":"Healthcare"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"e004042","DOI":"10.1136\/bmjgh-2020-004042","article-title":"Medical costs and out-of-pocket expenditures associated with multimorbidity in China: quantile regression analysis","volume":"6","author":"Zhao","year":"2021","journal-title":"BMJ Glob Health"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"5657","DOI":"10.3390\/ijerph18115657","article-title":"Health service utilization and out-of-pocket expenditure associated with the continuum of disability in Vietnam","volume":"18","author":"Nguyen","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1002\/pam.21985","article-title":"Comparing inference approaches for RD designs: a reexamination of the effect of head start on child mortality","volume":"36","author":"Cattaneo","year":"2017","journal-title":"J Policy Anal Manage"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1016\/j.jeconom.2007.05.005","article-title":"Manipulation of the running variable in the regression discontinuity design: a density test","volume":"142","author":"McCrary","year":"2008","journal-title":"J Econ"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1093\/jnci\/djn103","article-title":"Cost of Care for Elderly Cancer Patients in the United States","volume":"100","author":"Yabroff","year":"2008","journal-title":"JNCI J Natl Cancer Inst"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1158\/1055-9965.EPI-19-1534","article-title":"Medical care costs associated with Cancer survivorship in the United States","volume":"29","author":"Mariotto","year":"2020","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1093\/jnci\/djq495","article-title":"Projections of the cost of Cancer Care in the United States: 2010\u20132020","volume":"103","author":"Mariotto","year":"2011","journal-title":"JNCI J Natl Cancer Inst"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"943271","DOI":"10.3389\/fpubh.2022.943271","article-title":"Factors associated with health care utilization and catastrophic health expenditure among cancer patients in China: evidence from the China health and retirement longitudinal study","volume":"10","author":"Deng","year":"2022","journal-title":"Front Public Health"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"1668589","DOI":"10.3389\/fpubh.2025.1668589","article-title":"The shift of expenditure of medical service for diagnosis and treatment of colorectal cancer from 2005 to 2014: a hospital-based retrospective survey in Guangxi","volume":"13","author":"Liang","year":"2005","journal-title":"Front Public Health"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1057\/s41599-024-04295-5","article-title":"Nip it in the bud: the impact of China's large-scale free physical examination program on health care expenditures for elderly people","volume":"12","author":"Ma","year":"2025","journal-title":"Humanit Soc Sci Commun"},{"key":"ref59","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.3982\/ECTA11757","article-title":"Robust nonparametric confidence intervals for regression-discontinuity designs","volume":"82","author":"Calonico","year":"2014","journal-title":"Econometrica"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1822162\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:29:40Z","timestamp":1782365380000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1822162\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":59,"alternative-id":["10.3389\/fpubh.2026.1822162"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1822162","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]},"article-number":"1822162"}}