title: Managed care enrollment and chronically disabled women with breast cancer.
abstract: OBJECTIVE
  To assess whether managed care enrollment or healthcare utilization level among women enrolled in Medicare because of disability affects stage at diagnosis and treatment of breast cancer.
  
  
  METHODS
  Retrospective study using the Surveillance, Epidemiology, and End Results-Medicare database. We compared breast cancer stage at diagnosis and treatment among women with disabilities enrolled in Medicare managed care versus fee-for-service (FFS) Medicare. Women enrolled in FFS Medicare were classified into levels of healthcare utilization during the 6 to 18 months before breast cancer diagnosis.
  
  
  METHODS
  Controlling for confounders, we used regression models to determine the effects of managed care enrollment and healthcare utilization level on earlier stage at diagnosis and treatment of breast cancer.
  
  
  RESULTS
  Disabled patients enrolled in FFS Medicare without contact with the healthcare system and those with fewer than 12 physician visits during the 6 to 18 months before breast cancer diagnosis were more likely than disabled patients enrolled in Medicare managed care to be diagnosed as having breast cancer at a late stage. There was no difference between women enrolled in Medicare managed care versus women enrolled in FFS Medicare having at least 12 physician visits during the 12-month period. Breast cancer treatment for women with disabilities did not vary across managed care enrollment or healthcare utilization level.
  
  
  CONCLUSIONS
  Managed care enrollment or increased contact with healthcare providers could result in earlier stage at breast cancer diagnosis.
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, MMC 729, Minneapolis, MN 55455, USA. butz0030@umn.edu
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
authors.forename: Sara B
authors.initials: SB
authors.lastname: Durham
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Baxter
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000208:ethnology / Q000628:therapy*; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000145:classification / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008329:Managed Care Programs / Q000592:standards / Q000706:statistics & numerical data*; D016345:Medicare Part B / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D018426:SEER Program; D013997:Time Factors; D014481:United States; D014600:Utilization Review