The Relationship of HMOs, Health Insurance, and Delivery Systems to Breast Cancer Outcomes

BACKGROUND: The current climate of anger and frustration with managed care has heightened interest in the quality of health care provided by managed-care plans, particularly health maintenance organizations (HMOs). This breast cancer outcomes study, investigating relationships of health insurance and delivery systems to stage at diagnosis, treatment selected, and survival, is based in a heavily penetrated, highly competitive HMO market. METHODS: Data for 1,788 residents of northern California younger than 65 years of age at diagnosis (1987-1993) were provided by a population-based cancer registry. Patient insurance included fee-for-service (FFS), group-model HMO, nongroup HMO, publicly insured, and uninsured. Diagnosis and treatment occurred in 73 hospitals (large, medium/moderately small, or very small community, rural, teaching, or HMO-owned hospitals). Regression models examined relationships of insurance and hospital type to 3 outcomes (stage, treatment, and survival), controlling for age, ethnicity, education, neighborhood occupational class, and time period. RESULTS: Early diagnosis was as likely for group-model and nongroup-model HMO-insured patients as for the private FFS-insured patients. In 1987-1990, HMO-owned hospitals were leaders in treating 46% of early-stage breast cancers with breast-conserving surgery plus radiation (BCS+); by 1991-1993, the most significant increases in BCS+ use occurred at teaching and large community hospitals. Survival of group-model HMO, nongroup-model HMO, and FFS patients was not significantly different. Publicly insured/uninsured patients had more stage III/IV disease (OR=2.01, P = 0.006) and greater all-cause mortality (risk ratio 1.46, P = 0.015). CONCLUSIONS: Group-model and nongroup-model HMO patients are similar to FFS-insured patients in stage at diagnosis and survival outcomes. Treatment selection is related to hospital type rather than insurance coverage

Breast cancer · Cancer · Disease · Environmental health · Family medicine · Health care · Health maintenance · Managed care · Population · Demography · Economic and Financial Impacts of Cancer · Global Cancer Incidence and Screening · Healthcare Policy and Management · Internal Medicine · Medicine

• Origins of socio-economic inequalities in cancer survival

  Open Access•Laura M Woods, Bernard Rachet et al.•Annals of Oncology•2006

  Incluir item

• Effect of capitation payment method on health outcomes, healthcare utilization, and referrals in Ghana

  Open Access•Micheal Kofi Boachie, Eugenia Amporfu et al.•PLOS Global Public Health•2024

  Incluir item

• Health Care Factors Related to Stage at Diagnosis and Survival Among Medicare Patients With Colorectal Cancer

  Anna Lee-Feldstein, Anna Lee‐Feldstein et al.•Medical Care•2002

  Incluir item

• Health Insurance and Other Factors Associated With Mammography Surveillance Among Breast Cancer Survivors

  Susan A Sabatino, Trevor D Thompson et al.•Medical Care•2012

  Incluir item

• The Effects of Managed Care and Competition on Community-Based Clinical Research

  William R Carpenter, Bryan J Weiner et al.•Medical Care•2006

  Incluir item

• Care for Breast Cancer

  Ann B Nattinger•Medical Care•2000

  Incluir item

• Racial Inequities in the Timing of Breast Cancer Detection, Diagnosis, and Initiation of Treatment

  Joann G Elmore, Connie Y Nakano et al.•Medical Care•2005

  Incluir item

• Going Beyond Costs When Evaluating Surgical Options for Women Newly Diagnosed With Breast Cancer

  E Kathleen Adams•Medical Care•2001

  Incluir item

• Breast Cancer Stage at Diagnosis in Relation to Duration of Medicaid Enrollment

  Carin I Perkins, Carin Perkins et al.•Medical Care•2001

  Incluir item

• The Relation between Health Insurance Coverage and Clinical Outcomes among Women with Breast Cancer

  John Z Ayanian, Betsy A Kohler et al.•New England Journal of Medicine•1993

  Incluir item

• Measuring Social Class in US Public Health Research

  Nancy Krieger, David R Williams et al.•Annual Review of Public Health•1997

  Incluir item

• Determinants of late stage diagnosis of breast and cervical cancer

  Jeanne S Mandelblatt, J Mandelblatt et al.•American Journal of Public Health•1991

  Incluir item

• Changes in the use of screening mammography

  Nancy Breen, Larry G Kessler et al.•American Journal of Public Health•1994

  Incluir item

• Treating early-stage breast cancer

  M E Johantgen, Meg Johantgen et al.•American Journal of Public Health•1995

  Incluir item

• Dissemination of Clinical Results

  WANDA W YOUNG, STANLEY M MARKS et al.•Medical Care•1996

  Incluir item

• Stage at Diagnosis of Breast Cancer

  Pratibha R Kulkarni, Sally W Vernon et al.•Medical Care•1989

  Incluir item

• The Association Between Health Care Coverage and the Use of Cancer Screening Tests

  Arnold L Potosky, Nancy Breen et al.•Medical Care•1998

  Incluir item

• Type of Health Care Coverage and the Likelihood of Being Screened for Cancer

  Nancy P Gordon, Thomas G Rundall et al.•Medical Care•1998

  Incluir item