Breast Cancer Survival and Treatment in Health Maintenance Organization and Fee-for-Service Settings

摘要: Background: Enrollment in health maintenance organizations (HMOs) has increased rapidly during the past 10 years, reflecting a growing emphasis on care cost containment. To determine whether there is difference treatment and outcome for female patients with breast cancer enrolled HMOs versus fee-for-service setting, we compared 10-year survival initial of both types plans. Methods: With use tumor registries covering greater San Francisco‐Oakland Seattle‐Puget Sound areas, respectively, obtained information 13 358 cancer, aged 65 years older, diagnosed between 1985 1992. We linked registry Medicare data from two large included study. differences HMO after adjusting stage, comorbidity, sociodemographic characteristics. Results: In Francisco‐Oakland, adjusted risk ratio deaths among was 0.71 (95% confidence interval [CI] = 0.59‐0.87) comparable all deaths. Sound, 1.01 CI 0.77‐1.33) but somewhat lower Women were more likely to receive breast-conserving surgery than women (odds 1.55 Francisco‐ Oakland; 3.39 Seattle). enrollees undergoing also adjuvant radiotherapy (San odds 2.49; Seattle 4.62). Conclusions: Long-term outcomes prepaid group practice this study at least equal to, possibly better than, system. addition, recommended therapy early stage frequent HMOs. [J Natl Cancer Inst 1997; 89:1683‐91]