© 1997 by Oxford University Press
Journal Of The National Cancer Institute, Vol 89, 1683-1691, Copyright © 1997 by Oxford University Press
AL Potosky, RM Merrill, GF Riley, SH Taplin, W Barlow, BH Fireman and R Ballard- Barbash
BACKGROUND: Enrollment in health maintenance organizations (HMOs) has
increased rapidly during the past 10 years, reflecting a growing emphasis
on health care cost containment. To determine whether there is a difference
in the treatment and outcome for female patients with breast cancer
enrolled in HMOs versus a fee-for-service setting, we compared the 10-year
survival and initial treatment of patients with breast cancer enrolled in
both types of plans. METHODS: With the use of tumor registries covering the
greater San Francisco-Oakland and Seattle- Puget Sound areas, respectively,
we obtained information on the treatment and outcome for 13,358 female
patients with breast cancer, aged 65 years and older, diagnosed between
1985 and 1992. We linked registry information with Medicare data and data
from the two large HMOs included in the study. We compared the survival and
treatment differences between HMO and fee-for-service care after adjusting
for tumor stage, comorbidity, and sociodemographic characteristics.
RESULTS: In San Francisco-Oakland, the 10-year adjusted risk ratio for
breast cancer deaths among HMO patients compared with fee-for-service
patients was 0.71 (95% confidence interval [CI] = 0.59-0.87) and was
comparable for all deaths. In Seattle-Puget Sound, the risk ratio for
breast cancer deaths was 1.01 (95% CI = 0.77-1.33) but somewhat lower for
all deaths. Women enrolled in HMOs were more likely to receive
breast-conserving surgery than women in fee-for-service (odds ratio = 1.55
in San Francisco-Oakland; 3.39 in Seattle). HMO enrollees undergoing
breast-conserving surgery were also more likely to receive adjuvant
radiotherapy (San Francisco-Oakland odds ratio = 2.49; Seattle odds ratio =
4.62). CONCLUSIONS: Long-term survival outcomes in the two prepaid group
practice HMOs in this study were at least equal to, and possibly better
than, outcomes in the fee-for-service system. In addition, the use of
recommended therapy for early stage breast cancer was more frequent in the
two HMOs.
ARTICLES
Breast cancer survival and treatment in health maintenance organization and fee-for-service settings
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7344, USA. potosky@nih.gov
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