title: Managed care and cancer outcomes for Medicare beneficiaries with disabilities.
abstract: OBJECTIVE
  To determine if the type of insurance arrangement, specifically health maintenance organization (HMO) vs fee-for-service (FFS), affects cancer outcomes for Medicare beneficiaries with disabilities.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  We used the Surveillance, Epidemiology, and End Results-Medicare linked dataset to identify beneficiaries older and younger than 65 years entitled to Medicare benefits because of disability (Social Security Disability Insurance) who subsequently were diagnosed as having breast cancer (n = 6839) or non-small cell lung cancer (n = 10,229) from 1988 through 1999. We categorized persons according to Medicare insurance arrangement (continuous FFS, continuous HMO, or mixed FFS/HMO) during the periods 12 months before diagnosis and 6 months after diagnosis. Using a retrospective cohort design, we examined stage at diagnosis, cancer-directed treatments, and survival.
  
  
  RESULTS
  Women with continuous HMO insurance had earlier-stage breast cancer diagnosis (adjusted relative risk, 0.77; 95% confidence interval, 0.65-0.91) and were more likely to receive radiation therapy following breast-conserving surgery (adjusted relative risk, 1.11; 95% confidence interval, 1.03-1.19). Women having continuous HMO insurance had better breast cancer survival, primarily resulting from earlier-stage diagnosis. Among persons with non-small cell lung cancer, those having mixed FFS/HMO insurance were more likely to receive definitive surgery for early-stage disease (adjusted odds ratio, 1.23; 95% confidence interval, 1.02-1.49) and to have better overall survival but not significantly better lung cancer survival.
  
  
  CONCLUSIONS
  When diagnosed as having breast cancer or non-small cell lung cancer, some Medicare beneficiaries with disabilities fare better with managed care compared with FFS insurance plans.
authors.affiliation: Department of Family Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, MDC 13, Tampa, FL 33612, USA. rroetzhe@hsc.usf.edu
authors.forename: Richard G
authors.initials: RG
authors.lastname: Roetzheim
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Chirikos
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Wells
authors.forename: Ellen P
authors.initials: EP
authors.lastname: McCarthy
authors.forename: Long H
authors.initials: LH
authors.lastname: Ngo
authors.forename: Donglin
authors.initials: D
authors.lastname: Li
authors.forename: Reed E
authors.initials: RE
authors.lastname: Drews
authors.forename: Lisa I
authors.initials: LI
authors.lastname: Iezzoni
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000628:therapy; D006233:Persons with Disabilities; D018588:Fee-for-Service Plans; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000628:therapy; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy*; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States