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How might healthcare systems influence speed of cancer diagnosis: A narrative review

Brown, Sally; Castelli, Michele; Hunter, David J.; Erskine, Jonathan; Vedsted, Peter; Foot, Catherine; Rubin, Greg


Sally Brown

Michele Castelli

David J. Hunter

Jonathan Erskine

Peter Vedsted

Catherine Foot

Greg Rubin


Striking differences exist in outcomes for cancer between developed countries with comparable healthcare systems. We compare the healthcare systems of 3 countries (Denmark, Norway, Sweden), 3 UK jurisdictions (England, Wales and Northern Ireland), 3 Canadian provinces (British Columbia, Manitoba, Ontario) and 2 Australian states (New SouthWales, Victoria) using a framework which assesses the possible contribution of primary care systems to a range of health outcomes, drawing on key characteristics
influencing population health.
For many of the characteristics we investigated there are no significant differences between those countries with poorer cancer outcomes (England and Denmark) and the rest. In particular, regulation, financing, the existence of patient lists, the GP gatekeeping role, direct access to secondary care, the degree of comprehensiveness of primary care services, the level of cost sharing and the type of primary care providers within healthcare systems were not specifically and consistently associated with differences between countries. Factors that could have an influence on patient and professional behaviour, and
consequently contribute to delays in cancer diagnosis and poorer cancer outcomes in some countries, include centralisation of services, free movement of patients between primary care providers, access to secondary care, and the existence of patient list systems. It was not possible to establish a causal correlation between healthcare system characteristics and cancer outcomes. Further studies should explore in greater depth the associations between single health system factors and cancer outcomes, recognising that in complex systems where context is all-important, it will be difficult to establish causal relationships. Better understanding of the interaction between healthcare system variables and patient and professional behaviour may generate new hypotheses for further research.

Journal Article Type Article
Acceptance Date Jun 20, 2014
Online Publication Date Jun 23, 2014
Publication Date 2014-09
Deposit Date Apr 14, 2016
Publicly Available Date Feb 20, 2018
Journal Social Science and Medicine
Print ISSN 0277-9536
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 116
Pages 56-63
Keywords Cancer, primary care, health systems, international comparisons, early diagnosis
Public URL
Contract Date Feb 20, 2018


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