Baker Laurence C, Phillips Kathryn A, Haas Jennifer S, Liang Su-Ying, Sonneborn Dean
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
Health Serv Res. 2004 Dec;39(6 Pt 1):1751-72. doi: 10.1111/j.1475-6773.2004.00316.x.
Managed care may have widespread impacts on health care delivery for all patients in the areas where they operate. We examine the relationship between area managed care activity and screening for breast, cervical, and prostate cancer among patients enrolled in more managed care plans and patients who are enrolled in less managed plans.
Data on cancer screening from the 1996 Medical Expenditure Panel Survey (MEPS) were linked to data on health maintenance organization (HMO) and preferred provider organization (PPO) market share and HMO competition at the metropolitan statistical area (MSA) level. Logistic regression analysis was used to examine the relationship between area managed care prevalence and the use of mammography, clinical breast examination, Pap smear, and prostate cancer screening in the past two years, controlling for important covariates.
Among all patients, increases in area-level HMO market share are associated with increases in the appropriate use of mammography, clinical breast exam, and Pap smear (OR for high relative to low managed care areas are 1.75, p < .01, for mammography, 1.58, p < .05, for clinical breast exam, and 1.71, p < .01, for Pap smear). In analyses of subgroups, the relationship is significant only for individuals who are enrolled in the nonmanaged plans; there is no relationship for individuals in more managed plans. No relationship is observed between area HMO market share and prostate cancer screening in any analysis. Neither the level of competition between area HMOs nor area PPO market share is associated with screening rates.
Area-level managed care activity can influence preventive care treatment patterns.
管理式医疗可能会对其运营地区所有患者的医疗服务提供产生广泛影响。我们研究了地区管理式医疗活动与参与较多管理式医疗计划的患者以及参与较少管理式医疗计划的患者中乳腺癌、宫颈癌和前列腺癌筛查之间的关系。
1996年医疗支出面板调查（MEPS）中的癌症筛查数据与大都市统计区（MSA）层面的健康维护组织（HMO）和优选提供者组织（PPO）市场份额以及HMO竞争数据相关联。使用逻辑回归分析来研究地区管理式医疗普及率与过去两年中乳房X光检查、临床乳房检查、巴氏涂片检查和前列腺癌筛查的使用之间的关系，并控制重要的协变量。
在所有患者中，地区层面HMO市场份额的增加与乳房X光检查、临床乳房检查和巴氏涂片检查的合理使用增加相关（与低管理式医疗地区相比，高管理式医疗地区乳房X光检查的比值比为1.75，p < 0.01；临床乳房检查为1.58，p < 0.05；巴氏涂片检查为1.71，p < 0.01）。在亚组分析中，这种关系仅对参与非管理式计划的个体有显著意义；对于参与更多管理式计划的个体则没有关系。在任何分析中，均未观察到地区HMO市场份额与前列腺癌筛查之间的关系。地区HMO之间的竞争水平和地区PPO市场份额均与筛查率无关。
地区层面的管理式医疗活动可影响预防性医疗的治疗模式。
