title: Managed care market share and primary treatment for cancer.
abstract: OBJECTIVE
  Increases in the market share of managed care are associated with decreases in expenditures in the fee-for-service sector. To understand utilization patterns responsible for such savings, we assessed whether increases in managed care market share were related to increases in receipt of equally effective but less costly primary cancer therapies.
  
  
  METHODS
  Cancer registry data linked to Medicare administrative data for a population-based sample of fee-for-service Medicare beneficiaries 66 years and older who were diagnosed with breast or prostate cancer during 1993-1999.
  
  
  METHODS
  We used fixed-effects regression models to assess whether county-level increases in the market share of managed care were associated with differences in receipt of cancer therapies that are similar in effectiveness but vary in cost.
  
  
  RESULTS
  Increases in the market share of managed care were not associated with differences in the receipt of mastectomy versus breast-conserving surgery with radiation for women with early stage breast cancer (p=.47) or with the receipt of conservative therapy (versus surgery or radiation therapy) for men with local or regional prostate cancer (p=.30).
  
  
  CONCLUSIONS
  Increases in the market share of managed care do not appear to influence the receipt of equally effective primary treatments for cancer in the fee-for-service sector.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.forename: Ellen
authors.initials: E
authors.lastname: Meara
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.forename: Edward
authors.initials: E
authors.lastname: Guadagnoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D002391:Catchment Area, Health; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D006278:Medicare; D011320:Primary Health Care / Q000191:economics*; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D011859:Radiography; D012042:Registries; D014481:United States