Kirsner Robert S, Wilkinson James D, Ma Fangchao, Pacheco Heather, Federman Daniel G
Department of Epidemiology and Public Health, University of Miami School of Medicine, Miami, FL, USA.
Arch Dermatol. 2005 Jun;141(6):753-7. doi: 10.1001/archderm.141.6.753.
To evaluate differences in the stage at diagnosis and survival for melanoma between the 2 most common types of Medicare health care delivery systems, fee-for-service (FFS) and managed care (health maintenance organizations [HMOs]), in the United States during the period from January 1, 1985, through December 31, 1994.
We used a linkage of 2 national databases, ie, the Medicare database from the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) and the National Cancer Institute Surveillance, Epidemiology, and End Results program database, to evaluate differences in demographic data, stage at diagnosis, and survival for melanoma between the HMO and FFS groups. Patients A population of 4608 patients (62% men; 92% white).
We found an earlier stage of diagnosis for the HMO group compared with the FFS group for melanoma as the first cancer diagnosis, but this did not persist when melanoma was the second or a later cancer diagnosis. For patients with melanoma as the first cancer diagnosis, improved survival was related to earlier stage at diagnosis.
Differences exist in stage at diagnosis between patients in HMOs compared with those in FFS health care plans. This is likely due in part to utilization of services or access to care for patients in HMOs, and may be similar to that of patients in FFS plans with a previous cancer diagnosis before their diagnosis of melanoma. We did not find an increased risk of diagnosis with a late-stage cancer among patients with vs those without a previous cancer diagnosis. Improved survival appears to be related to earlier stage at diagnosis.
评估1985年1月1日至1994年12月31日期间，美国两种最常见的医疗保险提供系统（按服务收费[FFS]和管理式医疗[健康维护组织（HMO）]）中黑色素瘤患者的诊断分期和生存率差异。
我们将两个国家数据库进行了关联，即医疗保险和医疗补助服务中心（原医疗保健财务管理局）的医疗保险数据库以及美国国立癌症研究所的监测、流行病学和最终结果计划数据库，以评估HMO组和FFS组在人口统计学数据、黑色素瘤诊断分期和生存率方面的差异。患者为4608名患者组成的群体（62%为男性；92%为白人）。
我们发现，作为首个癌症诊断的黑色素瘤，HMO组的诊断分期早于FFS组，但当黑色素瘤为第二个或更晚的癌症诊断时，这种情况并未持续。对于首个癌症诊断为黑色素瘤的患者，生存率的提高与诊断时较早的分期有关。
HMO患者与FFS医疗保健计划患者的诊断分期存在差异。这可能部分归因于HMO患者对服务的利用或获得医疗服务的机会，并且可能与在诊断黑色素瘤之前已有癌症诊断的FFS计划患者类似。我们没有发现有癌症诊断史的患者与无癌症诊断史的患者相比，晚期癌症诊断风险增加。生存率的提高似乎与诊断时较早的分期有关。
