Journal of the National Cancer Institute Advance Access published online on July 8, 2008
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djn208
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© The Author 2008. Published by Oxford University Press.
ARTICLES |
Disenrollment From Medicare Managed Care Among Beneficiaries With and Without a Cancer Diagnosis
Affiliations of authors: Health Outcomes Research Group (EBE, PBB, CBB, DS), Department of Epidemiology and Biostatistics (EBE, NI, MG, PBB, CBB, DS), Memorial Sloan-Kettering Cancer Center, New York, NY; Office of Research, Development and Information, Centers for Medicare and Medicaid Services, Baltimore, MD (GFR)
Correspondence to: Elena B. Elkin, PhD, Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Box 44, New York, NY 10021 (e-mail: elkine{at}mskcc.org).
Background: Medicare managed care may offer enrollees lower out-of-pocket costs and provide benefits that are not available in the traditional fee-for-service Medicare program. However, managed care plans may also restrict provider choice in an effort to control costs. We compared rates of voluntary disenrollment from Medicare managed care to traditional fee-for-service Medicare among Medicare managed care enrollees with and without a cancer diagnosis.
Methods: We identified Medicare managed care enrollees aged 65 years or older who were diagnosed with a first primary breast (n = 28 331), colorectal (n = 26 494), prostate (n = 29 046), or lung (n = 31 243) cancer from January 1, 1995, through December 31, 2002, in Surveillance, Epidemiology, and End Results (SEER) cancer registry records linked with Medicare enrollment files. Cancer patients were pair-matched to cancer-free enrollees by age, sex, race, and geographic location. We estimated rates of voluntary disenrollment to fee-for-service Medicare in the 2 years after each cancer patient’s diagnosis, adjusted for plan characteristics and Medicare managed care penetration, by use of Cox proportional hazards regression.
Results: In the 2 years after diagnosis, cancer patients were less likely to disenroll from Medicare managed care than their matched cancer-free peers (for breast cancer, adjusted hazard ratio [HR] for disenrollment = 0.78, 95% confidence interval [CI] = 0.74 to 0.82; for colorectal cancer, HR = 0.84, 95% CI = 0.80 to 0.88; for prostate cancer, HR = 0.86, 95% CI = 0.82 to 0.90; and for lung cancer, HR = 0.81, 95% CI = 0.76 to 0.86). Results were consistent across strata of age, sex, race, SEER registry, and cancer stage.
Conclusion: A new cancer diagnosis between 1995 and 2002 did not precipitate voluntary disenrollment from Medicare managed care to traditional fee-for-service Medicare.
| CONTEXT AND CAVEATS Prior knowledge Medicare managed care may offer lower out-of-pocket costs and provide benefits that are not available in traditional fee-for-service Medicare. Study design Registry study of Medicare managed care enrollees that used Surveillance, Epidemiology, and End Results (SEER) records linked to Medicare enrollment files to obtain rates of voluntary disenrollment to fee-for-service Medicare for cancer patients in the 2 years after a cancer diagnosis and cancer-free enrollees. Contribution In the 2 years after diagnosis, patients diagnosed with breast, colorectal, prostate, or lung cancer were less likely to disenroll from Medicare managed care than their matched cancer-free peers. These results were consistent across strata of age, sex, race, SEER registry, and cancer stage. Implications If voluntary disenrollment is in fact the way that beneficiaries "vote with their feet," then these results suggest that those facing a serious illness are satisfied with Medicare managed care. Limitations Because Medicare does not process claims for managed care enrollees, no information was available on the medical or treatment information for cancer-free enrollees. No information was available on enrollees’ socioeconomic status or relationships with specific providers. From the Editors
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Dr P. B. Bach is on the Committee on Performance Measurement for the National Committee for Quality Assurance.
The authors gratefully acknowledge Joan Warren, the Applied Research Program (National Cancer Institute) and Information Management Services, Inc, for assistance with data acquisition and guidance in the use and interpretation of Medicare enrollment data.
The authors declare that they have no financial conflicts of interest. The authors maintained full responsibility for the design of the study, the collection of the data, the analysis and interpretation of the data, the decision to submit the manuscript for publication, and the writing of the manuscript.
Manuscript received December 19, 2007;
revised May 2, 2008; revised May 23, 2008;
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J Natl Cancer Inst 2008 100: 975.