Managed care and cancer outcomes for Medicare beneficiaries with disabilities.
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.
Roetzheim
Richard G
RG
Department of Family Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, MDC 13, Tampa, FL 33612, USA. rroetzhe@hsc.usf.edu
Chirikos
Thomas N
TN
Wells
Kristen J
KJ
McCarthy
Ellen P
EP
Ngo
Long H
LH
Li
Donglin
D
Drews
Reed E
RE
Iezzoni
Lisa I
LI
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