The effect of medicare health care systems on women with breast and cervical cancer

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

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

OBJECTIVE: Two common health care delivery systems in the United States are fee-for-service and managed care systems, including health maintenance organizations (HMOs). Differences may exist in patient outcomes depending upon the health care delivery system in which they are enrolled. We evaluated possible differences in the stage at diagnosis for breast and cervical cancer between 2 Medicare health care delivery systems (ie, fee for service and HMO) over the period 1985-2001. METHODS: We used a linkage of 2 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 stage at diagnosis between HMO and fee for service for breast and cervical cancer. RESULTS: We studied 130,336 Medicare-aged women with breast cancer (83% Medicare fee for service) and 6,758 women with cervical cancer (87% Medicare fee for service). We found an earlier stage of diagnosis for HMO patients, which remained significant after adjusting for potential confounding variables. Women enrolled in HMOs with breast cancer were 17% more likely and those with cervical cancer 35% more likely to be diagnosed at an in situ stage of diagnosis than fee-for-service patients. It is of note that when women had other cancer diagnoses, no statistically significant differences were seen in stage at diagnosis for either cancer between fee-for-service and HMO patients. CONCLUSION: Differences exist in stage at diagnosis between Medicare patients enrolled in HMOs compared with fee for service. This is likely due in part to use of or access to care.

Original languageEnglish
Pages (from-to)1381-1388
Number of pages8
JournalObstetrics and Gynecology
Volume105
Issue number6
DOIs
StatePublished - Jun 1 2005
Externally publishedYes

Fingerprint

Fee-for-Service Plans
Medicare
Health Maintenance Organizations
Uterine Cervical Neoplasms
Breast Neoplasms
Delivery of Health Care
Databases
SEER Program
Centers for Medicare and Medicaid Services (U.S.)
Confounding Factors (Epidemiology)
National Cancer Institute (U.S.)
Managed Care Programs
Early Diagnosis
Neoplasms

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Kirsner, R., Ma, F., Fleming, L., Trapido, E., Duncan, R., Federman, D. G., & Wilkinson, J. D. (2005). The effect of medicare health care systems on women with breast and cervical cancer. Obstetrics and Gynecology, 105(6), 1381-1388. https://doi.org/10.1097/01.AOG.0000161326.15602.fb

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

In: Obstetrics and Gynecology, Vol. 105, No. 6, 01.06.2005, p. 1381-1388.

Research output: Contribution to journalArticle

Kirsner, R, Ma, F, Fleming, L, Trapido, E, Duncan, R, Federman, DG & Wilkinson, JD 2005, 'The effect of medicare health care systems on women with breast and cervical cancer', Obstetrics and Gynecology, vol. 105, no. 6, pp. 1381-1388. https://doi.org/10.1097/01.AOG.0000161326.15602.fb
Kirsner, Robert ; Ma, Fangchao ; Fleming, Lora ; Trapido, Edward ; Duncan, Robert ; Federman, Daniel G. ; Wilkinson, James D. / The effect of medicare health care systems on women with breast and cervical cancer. In: Obstetrics and Gynecology. 2005 ; Vol. 105, No. 6. pp. 1381-1388.
@article{23cbd93ebe634871ac9af2efab139850,
title = "The effect of medicare health care systems on women with breast and cervical cancer",
abstract = "OBJECTIVE: Two common health care delivery systems in the United States are fee-for-service and managed care systems, including health maintenance organizations (HMOs). Differences may exist in patient outcomes depending upon the health care delivery system in which they are enrolled. We evaluated possible differences in the stage at diagnosis for breast and cervical cancer between 2 Medicare health care delivery systems (ie, fee for service and HMO) over the period 1985-2001. METHODS: We used a linkage of 2 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 stage at diagnosis between HMO and fee for service for breast and cervical cancer. RESULTS: We studied 130,336 Medicare-aged women with breast cancer (83{\%} Medicare fee for service) and 6,758 women with cervical cancer (87{\%} Medicare fee for service). We found an earlier stage of diagnosis for HMO patients, which remained significant after adjusting for potential confounding variables. Women enrolled in HMOs with breast cancer were 17{\%} more likely and those with cervical cancer 35{\%} more likely to be diagnosed at an in situ stage of diagnosis than fee-for-service patients. It is of note that when women had other cancer diagnoses, no statistically significant differences were seen in stage at diagnosis for either cancer between fee-for-service and HMO patients. CONCLUSION: Differences exist in stage at diagnosis between Medicare patients enrolled in HMOs compared with fee for service. This is likely due in part to use of or access to care.",
author = "Robert Kirsner and Fangchao Ma and Lora Fleming and Edward Trapido and Robert Duncan and Federman, {Daniel G.} and Wilkinson, {James D.}",
year = "2005",
month = "6",
day = "1",
doi = "10.1097/01.AOG.0000161326.15602.fb",
language = "English",
volume = "105",
pages = "1381--1388",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - The effect of medicare health care systems on women with breast and cervical cancer

AU - Kirsner, Robert

AU - Ma, Fangchao

AU - Fleming, Lora

AU - Trapido, Edward

AU - Duncan, Robert

AU - Federman, Daniel G.

AU - Wilkinson, James D.

PY - 2005/6/1

Y1 - 2005/6/1

N2 - OBJECTIVE: Two common health care delivery systems in the United States are fee-for-service and managed care systems, including health maintenance organizations (HMOs). Differences may exist in patient outcomes depending upon the health care delivery system in which they are enrolled. We evaluated possible differences in the stage at diagnosis for breast and cervical cancer between 2 Medicare health care delivery systems (ie, fee for service and HMO) over the period 1985-2001. METHODS: We used a linkage of 2 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 stage at diagnosis between HMO and fee for service for breast and cervical cancer. RESULTS: We studied 130,336 Medicare-aged women with breast cancer (83% Medicare fee for service) and 6,758 women with cervical cancer (87% Medicare fee for service). We found an earlier stage of diagnosis for HMO patients, which remained significant after adjusting for potential confounding variables. Women enrolled in HMOs with breast cancer were 17% more likely and those with cervical cancer 35% more likely to be diagnosed at an in situ stage of diagnosis than fee-for-service patients. It is of note that when women had other cancer diagnoses, no statistically significant differences were seen in stage at diagnosis for either cancer between fee-for-service and HMO patients. CONCLUSION: Differences exist in stage at diagnosis between Medicare patients enrolled in HMOs compared with fee for service. This is likely due in part to use of or access to care.

AB - OBJECTIVE: Two common health care delivery systems in the United States are fee-for-service and managed care systems, including health maintenance organizations (HMOs). Differences may exist in patient outcomes depending upon the health care delivery system in which they are enrolled. We evaluated possible differences in the stage at diagnosis for breast and cervical cancer between 2 Medicare health care delivery systems (ie, fee for service and HMO) over the period 1985-2001. METHODS: We used a linkage of 2 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 stage at diagnosis between HMO and fee for service for breast and cervical cancer. RESULTS: We studied 130,336 Medicare-aged women with breast cancer (83% Medicare fee for service) and 6,758 women with cervical cancer (87% Medicare fee for service). We found an earlier stage of diagnosis for HMO patients, which remained significant after adjusting for potential confounding variables. Women enrolled in HMOs with breast cancer were 17% more likely and those with cervical cancer 35% more likely to be diagnosed at an in situ stage of diagnosis than fee-for-service patients. It is of note that when women had other cancer diagnoses, no statistically significant differences were seen in stage at diagnosis for either cancer between fee-for-service and HMO patients. CONCLUSION: Differences exist in stage at diagnosis between Medicare patients enrolled in HMOs compared with fee for service. This is likely due in part to use of or access to care.

UR - http://www.scopus.com/inward/record.url?scp=19544385454&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=19544385454&partnerID=8YFLogxK

U2 - 10.1097/01.AOG.0000161326.15602.fb

DO - 10.1097/01.AOG.0000161326.15602.fb

M3 - Article

VL - 105

SP - 1381

EP - 1388

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 6

ER -