title: The effect of medicare health care delivery systems on survival for patients with breast and colorectal cancer.
abstract: BACKGROUND
  Two of the most common types of health care delivery systems in the U.S. are fee-for-service (FFS) and managed care systems such as health maintenance organizations (HMO). Differences may exist in patient outcomes depending on the health care delivery system in which they are enrolled. We evaluated differences in the survival of patients with breast and colorectal cancer at diagnosis between the two Medicare health care delivery systems (FFS and HMO).
  
  
  METHODS
  We used a linkage of two national databases, the Medicare database from the Centers for Medicare and Medicaid Services, and the National Cancer Institute's Surveillance, Epidemiology, and End Results program database, to evaluate differences in demographic data, stage at diagnosis, and survival between breast and colorectal cancer over the period 1985 to 2001.
  
  
  RESULTS
  Medicare patients enrolled in HMOs were diagnosed at an earlier stage of diagnosis than FFS patients. HMO patients diagnosed with breast and colorectal cancer had improved survival, and these differences remained even after controlling for potential confounders (such as stage at diagnosis, age, race, socioeconomic status, and marital status). Specifically, patients enrolled in HMOs had 9% greater survival in hazards ratio if they had breast cancer, and 6% if they had colorectal cancer.
  
  
  CONCLUSIONS
  Differences exist in survival among patients in HMOs compared with FFS. This is likely due to a combination of factors, including but not limited to, earlier stage at the time of diagnoses.
authors.affiliation: Department of Dermatology, University of Miami, FL 33101, USA. Rkirsner@med.miami.edu
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kirsner
authors.forename: Fangchao
authors.initials: F
authors.lastname: Ma
authors.forename: Lora
authors.initials: L
authors.lastname: Fleming
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Federman
authors.forename: Edward
authors.initials: E
authors.lastname: Trapido
authors.forename: Robert
authors.initials: R
authors.lastname: Duncan
authors.forename: James D
authors.initials: JD
authors.lastname: Wilkinson
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D018588:Fee-for-Service Plans; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D006278:Medicare; D018426:SEER Program; D016019:Survival Analysis; D014481:United States