title: The impact of managed health care in the United States on women with breast cancer and the providers who treat them.
abstract: This article describes how the increasing shift to managed care has impacted the treatment of women with breast cancer, from the perspectives of patients and providers. A descriptive exploratory pilot study was undertaken in a comprehensive cancer center in an urban northeastern city of the United States. The use of General Systems Theory is used to describe how the health care system has adapted to recent insurance changes. Qualitative interviews with patients,physicians, nurses, and business office staff reveal that the type of insurance did not affect treatment decisions. Findings from this pilot study, however, reveal that the increasing shift to managed care has resulted in a change in roles for nurses, fragmentation of care, and intangible costs to the patients.
authors.affiliation: University of Pennsylvania, School of Social Work, Philadelphia, Pennsylvania 19104, USA. jerry@ssw.upenn.edu
authors.forename: Joretha N
authors.initials: JN
authors.lastname: Bourjolly
authors.forename: Karen B
authors.initials: KB
authors.lastname: Hirschman
authors.forename: Nancy Anne
authors.initials: NA
authors.lastname: Zieber
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000191:economics / Q000628:therapy*; D005260:Female; D006801:Humans; D008329:Managed Care Programs / Q000592:standards*; D008875:Middle Aged; D009511:New England; D024802:Nurse's Role; D016522:Oncology Service, Hospital / Q000458:organization & administration* / Q000592:standards; D010865:Pilot Projects; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011787:Quality of Health Care