Understanding Heterogeneity Among Individuals Skipping Population-Based Health Screenings

Background and Purpose: Despite the importance of having routine health screenings, screening rates are low even in the countries, such as Korea, where universal health coverage ensures no or minimal financial burden. To better understand those who do not participate in routine health screenings, this panel study examined (1) the reported reasons why Korean adults skipped recommended health screenings at baseline (2006), and (2) whether their probabilities of receiving health screenings had changed differently in the following years (2008-2020) by the reason for not seeking preventive screenings at baseline.

Methods: This study analyzed 4,846 Koreans (aged 45+) from the 2006 Korean Longitudinal Study of Aging (KLoSA) who reported not having received any recommended health screenings in the previous two years. For those who had skipped the national health screening service, the KLoSA asked a primary reason with eight response options (e.g., physical limitations, lack of time, fear of getting a diagnosis). In the following waves (2008-2020), the KLoSA assessed respondent’s health screening status (yes/no) every two years. Multilevel mixed-effects logistic regression models were tested to examine longitudinal changes in health screening status over time.

Results: In 2006, 47.3% did not receive recommended free public health screenings. The most frequent reasons chosen were “unnecessary” (42.3%) and “lack of time” (21.7%). Among non-participants in 2006, the overall likelihood of receiving health screenings significantly increased over the next 14 years (OR_year=1.38, p<.001; OR_year²=0.98, p<.001) after adjusting the effects of time-varying covariates (demographic and socioeconomic characteristics, health and functional status, hospitalization). However, the trajectories of receiving health screenings showed significant group differences by the reported reason for skipping health screenings at baseline (2006) and significant interactions were also found between time and the reasons for skipping health screenings. As a result, those who reported “physical limitations” as a primary reason for not receiving health screening at baseline continuously showed the lowest rates over time and their rates of increase was significantly lower compared with those who answered “lack of time” (p<.01), “unnecessary” (<.05), and “having previous exam results indicating no problem” (p<.05). Those who believed that there would be “no cure” if a disease was found showed the second lowest probabilities of receiving routine health screenings over time.

Conclusions and Implications: By studying adults in Korea where universal national health insurance provides a population-based health screening program for free of charge, this study naturally controlled for health insurance status, one of the significant enabling factors that affect health service use. The results highlight the importance of tailored health promotion efforts that incorporate different health beliefs and physical barriers of vulnerable non-users.