Quality of care for colorectal cancer in a fee-for-service and health maintenance organization practice

Abstract

This study assessed the effectiveness of two types of health plans, offered by the same health care provider, in the diagnosis and treatment of colorectal cancer. Data on 330 cases diagnosed from 1984 through 1989 were abstracted from medical records. Of these, 205 (62%) used fee‐for‐service (FFS) and 125 (38%) used health maintenance organization (HMO) plans. Overall, there were no differences between FFS and HMO cases for duration of symptoms before diagnosis, training of physician who diagnosed the tumor, anatomic location of the tumor, type of primary treatment, Dukes' stage at final diagnosis, or survival. There were differences between the groups for age, presence of symptoms at diagnosis, time from detection to treatment, and method of detection. Cox regression analysis showed no difference in survival by type of health plan before or after adjusting for age and stage at diagnosis. The findings from this study are consistent with those from studies reporting little or no difference in the process or outcome of care for patients with different types of medical insurance coverage. Cancer 1992; 692418‐2425.

Effects of health insurance and race on colorectal cancer treatments and outcomes

“…[19][20][21][22]41 Studies reported by Retchin et al 20,21 and Merrill et al 41 were restricted to patients insured by Medicare, a group for which we also found no differences in outcomes. Studies reported by Francis et al 22 and by Vernon et al 19 were not population based and were restricted to patients residing in single metropolitan areas (Seattle and Houston, respectively) that may not be representative of other parts of the country. Our results suggest that care and outcomes for nonMedicare colorectal cancer patients with FFS insurance and for those patients with HMO insurance may be different.…”

“…Studies have found no difference in treatments or outcomes between fee-forservice (FFS) and HMO insurance types, but most studies have not been population based. [19][20][21][22] Lacking health insurance and having Medicaid as an insurance payer have both been associated with different treatment patterns and poor outcomes in patients with breast cancer, but they have not been adequately studied among patients with colorectal cancer. [23][24][25][26] It is not certain, therefore, to what extent race and insurance payer influence the care and outcomes for patients diagnosed with colorectal cancer.…”

The Impact of Financial Incentives on Quality of Health Care

“…Sources: Young and Cohen 1991;Carlisle et al 1992;Vernon et al 1992;Langa and Sussman 1993;Manton et al 1993;Lee-Feldstein, Anton-Culver, and Feldstin 1994;Shaughnessy, Schlenker, and Hittle 1994;Angus et al 1996;Lave et al 1996;Phibbs et al 1996;Starr et al 1996;Yelin, Criswell, and Feigenbaum 1996;Retchin et al 1997.…”

“…Sources: Cummings et al 1989;Wells et al 1989;Bredfeldt, Brewer, and Junker 1990;Brown 1990a,b, 1991;Preston and Retchin 1991;Retchin and Preston 1991;Carlisle et al 1992;Miller and Luft 1992;Vernon et al 1992;Wells et al 1994;Coffey et al 1995;O'Toole et al 1996.…”

The Impact of Managed Care on Health Care Utilization Among Adults with Asthma

“…However, the literature on the impact of managed care now contains numerous studies conducted among persons with discrete chronic conditions (25), including, for example, cancer (26), cardiovascular disease (27 -29), mental health conditions (30), diabetes (29), and rheumatic disease (31 -33), among others. In these studies, the weight of the evidence is that managed care and FFS provide similar kinds and amounts of care to those with specific conditions (9).…”