Breast cancer survival and treatment in health maintenance organization and fee-for-service settings.
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.
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.
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. (...)
Mots-clés Pascal : Tumeur maligne, Glande mammaire, Organisation santé, Assurance maladie, Système santé, Traitement, Pronostic, Etude comparative, Etats Unis, Amérique du Nord, Amérique, Homme, Glande mammaire pathologie
Mots-clés Pascal anglais : Malignant tumor, Mammary gland, Public health organization, Health insurance, Health system, Treatment, Prognosis, Comparative study, United States, North America, America, Human, Mammary gland diseases
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0100706
Code Inist : 002B20E02. Création : 22/06/1998.