title: Disenrollment from Medicare managed care among beneficiaries with and without a cancer diagnosis.
abstract: BACKGROUND
  Medicare managed care may offer enrollees lower out-of-pocket costs and provide benefits that are not available in the traditional fee-for-service Medicare program. However, managed care plans may also restrict provider choice in an effort to control costs. We compared rates of voluntary disenrollment from Medicare managed care to traditional fee-for-service Medicare among Medicare managed care enrollees with and without a cancer diagnosis.
  
  
  METHODS
  We identified Medicare managed care enrollees aged 65 years or older who were diagnosed with a first primary breast (n = 28 331), colorectal (n = 26 494), prostate (n = 29 046), or lung (n = 31 243) cancer from January 1, 1995, through December 31, 2002, in Surveillance, Epidemiology, and End Results (SEER) cancer registry records linked with Medicare enrollment files. Cancer patients were pair-matched to cancer-free enrollees by age, sex, race, and geographic location. We estimated rates of voluntary disenrollment to fee-for-service Medicare in the 2 years after each cancer patient's diagnosis, adjusted for plan characteristics and Medicare managed care penetration, by use of Cox proportional hazards regression.
  
  
  RESULTS
  In the 2 years after diagnosis, cancer patients were less likely to disenroll from Medicare managed care than their matched cancer-free peers (for breast cancer, adjusted hazard ratio [HR] for disenrollment = 0.78, 95% confidence interval [CI] = 0.74 to 0.82; for colorectal cancer, HR = 0.84, 95% CI = 0.80 to 0.88; for prostate cancer, HR = 0.86, 95% CI = 0.82 to 0.90; and for lung cancer, HR = 0.81, 95% CI = 0.76 to 0.86). Results were consistent across strata of age, sex, race, SEER registry, and cancer stage.
  
  
  CONCLUSIONS
  A new cancer diagnosis between 1995 and 2002 did not precipitate voluntary disenrollment from Medicare managed care to traditional fee-for-service Medicare.
authors.affiliation: Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Box 44, New York, NY 10021, USA. elkine@mskcc.org
authors.forename: Elena B
authors.initials: EB
authors.lastname: Elkin
authors.forename: Nicole
authors.initials: N
authors.lastname: Ishill
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Riley
authors.forename: Peter B
authors.initials: PB
authors.lastname: Bach
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Colin B
authors.initials: CB
authors.lastname: Begg
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000453:epidemiology; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D006278:Medicare; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000453:epidemiology; D018426:SEER Program; D014481:United States