Evaluation on Cervical Cancer Prevention and Treatment Policy in Taiwan

Cervical cancer is the most frequent cancer and the fifth leading cancer death cause for women in Taiwan. The cervical cancer incidence in Taiwan was one of the highest in Asia. Unlike many other cancers, a significant proportion of the cervical cancer incidence and mortality is essentially preventable through the use of screening tools such as Pap smear. Until the implementation of the National Health Insurance (NHI) program in 1995, no nationwide cervical cancer screening program had been available in Taiwan. All women in Taiwan over the age of 30 years are now provided with free annual Pap smears under the NHI program. The coverage rate of Pap smear test increased from 14.3% in 1996 to 28.4% in 2009. The three-year coverage rate reached 52.3% in the same year. Compared with the three- to five-year coverage rates of 75% in many European countries, the screening program in Taiwan has not achieved a satisfactory coverage by now. In the past fifteen years or so, the health authorities in Taiwan having implemented many programs aimed at increasing the screening rate and improving the care quality of subsequent diagnosis and treatment. However, few policy evaluation has been conducted on the effectiveness of these programs. The present research project is, therefore, aiming to evaluating the effectiveness of recent policies aimed at improving the cervical cancer screening and treatment. In the 1st year, by linking the NHI claims dataset and cancer registry, the distribution of cervical cancer staging at diagnosis and the survival rate will be compared to see whether the implementation of a pay-for-performance payment scheme in 2001 improve the early diagnosis of cervical cancer and improve the prognosis of survival. In the 2nd year, by trend of hospice care utilization will be evaluated prior to the death of cervical cancer patients to see if policies encouraged patients to choose hospice care. Finally in the 3rd year, compliance with the treatment guidelines will be evaluated to see if Cancer Certificated Institution programs improve the compliance of good quality of care. A difference-in-difference (DID) approach will be undertaken to assess the policy impacts.