title: Evaluation of breast cancer care under Puerto Rico's Health Care Reform.
abstract: Puerto Rico has implemented Health Care Reform legislation that shifted medically indigent and underserved persons from direct care by public sector institutions to managed care arrangements through the private sector. Our aim is to assess how previously underserved women with breast cancer have fared during the first three years of the Reform. Medical claims data were obtained on breast cancer cases in San Juan who were either enrolled in the capitated Reform plan or in a commercial policy offered by the same insurer. A set of indicators reflecting initial therapy, use of key services, and cumulative utilization rates of various medical procedures were constructed. Statistical tests were conducted to assess whether these indicators differed between Reform- and commercially-insured patients. Failure to reject null hypotheses of indicator differences were then used to judge Reform progress. We found some differences, but they were neither pervasive nor unidirectional. On balance, we conclude that previously underserved women are being treated for breast cancer roughly on par with other patients. This conclusion, however, is preliminary and subject to important qualifications.
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute at the University of South Florida, USA. chirikos@moffitt.usf.edu
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Chirikos
authors.forename: Josefina
authors.initials: J
authors.lastname: López-Garcia
authors.forename: Cristóbal
authors.initials: C
authors.lastname: Cintrón Vargas
authors.forename: Omayra L
authors.initials: OL
authors.lastname: Gonzalez
authors.forename: Maria P
authors.initials: MP
authors.lastname: Pérez-Grau
authors.forename: Luis
authors.initials: L
authors.lastname: Baez-Diaz
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000628:therapy*; D005260:Female; D018166:Health Care Reform; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D008329:Managed Care Programs; D008489:Medical Indigency; D008507:Medically Underserved Area; D008875:Middle Aged; D017149:Private Sector; D011647:Puerto Rico; D011787:Quality of Health Care