Sustainability of cancer screening in China: a multicentre assessment from the perspective of service suppliers and demanders

Abstract Background In 2012, China's central government initiated the Cancer ScreeningProgram in Urban China (CanSPUC). The aim of this study was, based on the CanSPUC, to assess the long-term sustainability of cancer screeningin China. Methods This multicentre survey was conducted in 17 provinces across China between Oct 8, 2012, and Sept 15, 2015. 54 250 web-based or face-to-face interviews were completed among participants from four perspectives: actual suppliers of screening services (n=4626); potential suppliers (n=2201); actual demanders of screening services (n=31 029); and potential demanders (16 394). All percentages were calculated after eliminating missing values. Findings From the perspective of actual suppliers of screening services, the main gains from providing screening emphasised promotion in social value (63·6%; n=2926), local reputation (35·9%; n=1654), and professional skills (30·6%; n=1408), whereas difficulties encountered included inadequate compensation (30·9%; n=1421) and discordance among information systems (28·3%; n=1303). 2936 (63·7%) expressed willingness to provide routine screening. From the perspective of potential suppliers, the management personnel subgroup (n=508) were most willing in implementing the service (92·5%; n=459) and preferred it being financed by governments (68·3%; n=334) or insurance agencies (14·3%; n=70); the clinical professional subgroup (n=1693) were also most interested in professional skills improvement through the project (72·4%; n=1225). Among the actual demanders of screening services, 19 448 (94·6%) thought the involved screening technologies acceptable, more than 20 905 (>67·3%) preferred annual, biennial, or triennial screening frequency, and more than three-quarters were willing to pay for screening, but only 2659 (11·2%) were willing to pay more than ¥500 (about US$70). Among the potential demanders, 12 738 (77·7%) had never received cancer screeningand 4719 (43·7%) preferred screening at general hospitals, but only 3928 (36·4%) would choose a hospital at reasonable level. Willingness to pay was similar between potentialand actualdemanders. Interpretation Differences and consistencies between actual and potential suppliers of screening services indicated the aspects that need to be strengthened in longer-term management. Both actual and potential demanders of screening services showed considerable demand or acceptability for screening. The low willingness to pay from multiple perspectives suggests the importance of introducing stable co-compensation mechanisms mainly supported by local governments and the medical insurance systems. Funding National Health and Family Planning Commission of China; China-WHO Biennial Collaborative Projects (2016/664439-0).