title: Survival and treatment for colorectal cancer Medicare patients in two group/staff health maintenance organizations and the fee-for-service setting.
abstract: The current study compares treatment use and long-term survival in colorectal cancer patients between Medicare beneficiaries enrolled in two large prepaid group/staff health maintenance organizations (HMOs) and the fee-for-service (FFS) setting. The study is based on 15,352 colorectal cancer cases diagnosed between 1985 and 1992 and followed through 1995. Survival differences between the HMO and FFS cases were assessed using Cox regression. Treatment differences were evaluated using logistic regression. HMO cases had a lower overall mortality than did FFS cases but not a significantly lower colorectal cancer-specific mortality. Use of surgical resection was similar between HMO and FFS cases. However, rectal cancer cases in the HMOs were more likely to receive postsurgical radiation therapy than FFS cases. Superior overall survival in the HMOs may be the result of increased colorectal cancer screening, greater use of adjuvant therapies, and selection of healthier individuals.
authors.affiliation: Brigham Young University, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Merrill
authors.forename: M L
authors.initials: ML
authors.lastname: Brown
authors.forename: A L
authors.initials: AL
authors.lastname: Potosky
authors.forename: G
authors.initials: G
authors.lastname: Riley
authors.forename: S H
authors.initials: SH
authors.lastname: Taplin
authors.forename: W
authors.initials: W
authors.lastname: Barlow
authors.forename: B H
authors.initials: BH
authors.lastname: Fireman
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000628:therapy*; D003627:Data Interpretation, Statistical; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D006125:Group Practice, Prepaid / Q000706:statistics & numerical data; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D015273:Insurance Selection Bias; D016015:Logistic Models; D008297:Male; D006278:Medicare; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012495:San Francisco / Q000453:epidemiology; D016019:Survival Analysis; D014481:United States; D014861:Washington / Q000453:epidemiology