The effect of medicare health care delivery systems on survival for patients with breast and colorectal cancer

Robert Kirsner, Fangchao Ma, Lora Fleming, Daniel G. Federman, Edward Trapido, Robert Duncan, James D. Wilkinson

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Two of the most common types of health care delivery systems in the U.S. are fee-for-service (FFS) and managed care systems such as health maintenance organizations (HMO). Differences may exist in patient outcomes depending on the health care delivery system in which they are enrolled. We evaluated differences in the survival of patients with breast and colorectal cancer at diagnosis between the two Medicare health care delivery systems (FFS and HMO). Methods: We used a linkage of two national databases, the Medicare database from the Centers for Medicare and Medicaid Services, and the National Cancer Institute's Surveillance, Epidemiology, and End Results program database, to evaluate differences in demographic data, stage at diagnosis, and survival between breast and colorectal cancer over the period 1985 to 2001. Results: Medicare patients enrolled in HMOs were diagnosed at an earlier stage of diagnosis than FFS patients. HMO patients diagnosed with breast and colorectal cancer had improved survival, and these differences remained even after controlling for potential confounders (such as stage at diagnosis, age, race, socioeconomic status, and marital status). Specifically, patients enrolled in HMOs had 9% greater survival in hazards ratio if they had breast cancer, and 6% if they had colorectal cancer. Conclusions: Differences exist in survival among patients in HMOs compared with FFS. This is likely due to a combination of factors, including but not limited to, earlier stage at the time of diagnoses.

Original languageEnglish
Pages (from-to)769-773
Number of pages5
JournalCancer Epidemiology Biomarkers and Prevention
Volume15
Issue number4
DOIs
StatePublished - Apr 1 2006

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Medicare
Health Maintenance Organizations
Colorectal Neoplasms
Fee-for-Service Plans
Breast Neoplasms
Delivery of Health Care
Survival
Databases
SEER Program
Centers for Medicare and Medicaid Services (U.S.)
National Cancer Institute (U.S.)
Marital Status
Managed Care Programs
Social Class
Early Diagnosis
Demography

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

The effect of medicare health care delivery systems on survival for patients with breast and colorectal cancer. / Kirsner, Robert; Ma, Fangchao; Fleming, Lora; Federman, Daniel G.; Trapido, Edward; Duncan, Robert; Wilkinson, James D.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 15, No. 4, 01.04.2006, p. 769-773.

Research output: Contribution to journalArticle

Kirsner, Robert ; Ma, Fangchao ; Fleming, Lora ; Federman, Daniel G. ; Trapido, Edward ; Duncan, Robert ; Wilkinson, James D. / The effect of medicare health care delivery systems on survival for patients with breast and colorectal cancer. In: Cancer Epidemiology Biomarkers and Prevention. 2006 ; Vol. 15, No. 4. pp. 769-773.
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