© 2005 Oxford University Press
ARTICLE |
Do Increases in the Market Share of Managed Care Influence Quality of Cancer Care in the Fee-For-Service Sector?
Affiliations of authors: Department of Health Care Policy (NLK, MBL, EM, EG), Harvard Medical School; the Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA (NLK); the Schools of Medicine and Public Health, and Jonsson Cancer Center, University of California, Los Angeles, CA (PAG)
Correspondence to: Nancy L. Keating, MD, MPH, Department of Health Care Policy, Harvard Medical School, Boston, MA 02115 (e-mail: keating{at}hcp.med.harvard.edu).
Background: Increases in the market share of managed care in an area are associated with decreases in expenditures in the fee-for-service sector (i.e., a spillover effect). Given concerns that these decreases in expenditures result from reductions in necessary care, we examined associations between increases in managed care market share and changes in the quality of care delivered to cancer patients in the fee-for-service sector. Methods: We studied a population-based sample of fee-for-service Medicare beneficiaries aged 66 years or older who were diagnosed with breast (N = 41 394) or colorectal (N = 48 027) cancer during 1993–1999. We used fixed effects regression analysis of SEER cancer registry and Medicare claims data to assess whether county-level increases in the market share of managed care over time were associated with the quality of cancer care. All statistical tests were two-sided. Results: Increases in the market share of managed care were not associated with most quality indicators, including receipt of surveillance mammography after diagnosis for patients with breast cancer (P = .83), receipt of radiation after breast-conserving surgery among women who underwent breast-conserving surgery (P = .16), receipt of adjuvant chemotherapy for patients with stage III colorectal cancer (P = .94), or surveillance colonoscopy after treatment for colorectal cancer (P = .39). Increases in the market share of managed care were associated with increased rates of surveillance carcinoembryonic antigen testing for colorectal cancer patients (P = .001). Conclusions: Increases in managed care market share had limited or no effect on the quality of care for cancer patients. Concerns that increases in managed care would have large negative spillover effects on the quality of cancer care appear to be unfounded; however, the potential for managed care to stimulate improved quality throughout the medical care system have not yet been realized.
CiteULike 
Connotea 
Del.icio.us What's this?
Editorial about this Article
- Managed Care Market Penetration, Spillover Effects, and the Quality of Cancer Care
- Joseph Lipscomb
J Natl Cancer Inst 2005 97: 242-244.[Extract] [Full Text] [PDF]
Related Memo to the Media
- Press Release: Study Examines Effect of Managed Care on Quality of Care for Cancer Patients
- Sarah L. Zielinski
J Natl Cancer Inst 2005 97: 241.[Extract] [Full Text]
This article has been cited by other articles:
|
|
 |
|
  N. L. Keating, M. B. Landrum, C. N. Klabunde, R. H. Fletcher, S. O. Rogers, W. R. Doucette, D. Tisnado, S. Clauser, and K. L. Kahn Adjuvant Chemotherapy for Stage III Colon Cancer: Do Physicians Agree About the Importance of Patient Age and Comorbidity? J. Clin. Oncol., May 20, 2008; 26(15): 2532 - 2537. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. B. Landrum, E. R. Meara, A. Chandra, E. Guadagnoli, and N. L. Keating Is Spending More Always Wasteful? The Appropriateness Of Care And Outcomes Among Colorectal Cancer Patients Health Aff., January 1, 2008; 27(1): 159 - 168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. L. Keating, M. B. Landrum, E. Guadagnoli, E. P. Winer, and J. Z. Ayanian Surveillance Testing Among Survivors of Early-Stage Breast Cancer J. Clin. Oncol., March 20, 2007; 25(9): 1074 - 1081. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. Kirsner, F. Ma, L. Fleming, D. G. Federman, E. Trapido, R. Duncan, and J. D. Wilkinson The effect of medicare health care delivery systems on survival for patients with breast and colorectal cancer. Cancer Epidemiol. Biomarkers Prev., April 1, 2006; 15(4): 769 - 773. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. L. Keating, M. B. Landrum, E. Guadagnoli, E. P. Winer, and J. Z. Ayanian Factors Related to Underuse of Surveillance Mammography Among Breast Cancer Survivors J. Clin. Oncol., January 1, 2006; 24(1): 85 - 94. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Herbst, D. F. Bajorin, H. Bleiberg, D. Blum, D. Hao, B. E. Johnson, R. F. Ozols, G. D. Demetri, P. A. Ganz, M. G. Kris, et al. Clinical Cancer Advances 2005: Major Research Advances in Cancer Treatment, Prevention, and Screening--A Report From the American Society of Clinical Oncology J. Clin. Oncol., January 1, 2006; 24(1): 190 - 205. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Lipscomb Managed Care Market Penetration, Spillover Effects, and the Quality of Cancer Care J Natl Cancer Inst, February 16, 2005; 97(4): 242 - 244. [Full Text] [PDF]
|
|