title: Use of preventive services by Medicare fee-for-service beneficiaries: does spillover from managed care matter?
abstract: BACKGROUND
  Health care delivery varies with the level of managed care activity (MCA) in an area, potentially affecting health care for those not participating in managed care programs. However, the extent to which MCA is associated with the use of cancer screening by fee-for-service beneficiaries (FFS) is unclear.
  
  
  OBJECTIVE
  We sought to study colorectal cancer screening among Medicare FFS beneficiaries in relation to levels of Medicare MCA.
  
  
  METHODS
  This study linked 1999 Medicare denominator and Part B claims data with the 1998 Area Resource File. After categorizing MCA as low (<10%), moderate (10-29.99%), or high (> or =30%), we assessed the association between colorectal cancer screening among FFS beneficiaries and MCA, controlling for individual demographic variables and county-level attributes of socioeconomic status and physician resources.
  
  
  METHODS
  We included Medicare FFS beneficiaries 65 years of age or older with both Part A and Part B coverage for the entire calendar year from large counties in the study.
  
  
  METHODS
  We measured the likelihood of undergoing fecal occult blood testing (FOBT), flexible sigmoidoscopy (FLEX), or colonoscopy (COL).
  
  
  RESULTS
  Compared with Medicare FFS beneficiaries residing in counties with low MCA, those in high MCA counties were significantly more likely to undergo FOBT (adjusted odds ratio [AOR] 1.10, 95% confidence interval [CI] 1.04-1.16), FLEX (AOR 1.11, 95% CI 1.04-1.18), or colonoscopy, after receiving FOBT/FLEX (AOR 1.07, 95% CI 1.02-1.13).
  
  
  CONCLUSIONS
  From a public health perspective, an association between higher levels of MCA and colorectal cancer screening among those not enrolled in managed care may translate into modest increases in use of colorectal cancer screening and possibly earlier detection.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4945, USA. skoroukian@case.edu
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
authors.forename: David
authors.initials: D
authors.lastname: Litaker
authors.forename: Avi
authors.initials: A
authors.lastname: Dor
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cooper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D019992:Databases as Topic; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D016345:Medicare Part B / Q000458:organization & administration / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009780:Occult Blood; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D012812:Sigmoidoscopy / Q000191:economics / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review