Toggle Main Menu Toggle Search

Open Access padlockePrints

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

Lookup NU author(s): Dr Michele Castelli, Emeritus Prof David Hunter, Emeritus Professor Greg RubinORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


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 South Wales, 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. © 2014 The Authors.

Publication metadata

Author(s): Brown S, Castelli M, Hunter DJ, Erskine J, Vedsted P, Foot C, Rubin G

Publication type: Article

Publication status: Published

Journal: Social Science and Medicine

Year: 2014

Volume: 116

Pages: 56-63

Print publication date: 01/09/2014

Online publication date: 23/06/2014

Acceptance date: 20/06/2014

Date deposited: 01/09/2017

ISSN (print): 0277-9536

ISSN (electronic): 1873-5347

Publisher: Elsevier Ltd


DOI: 10.1016/j.socscimed.2014.06.030

PubMed id: 24980792


Altmetrics provided by Altmetric