Kirsner Robert S, Ma Fangchao, Fleming Lora, Federman Daniel G, Trapido Edward, Duncan Robert, Wilkinson James D
Department of Dermatology, University of Miami, FL 33101, USA.
Cancer Epidemiol Biomarkers Prev. 2006 Apr;15(4):769-73. doi: 10.1158/1055-9965.EPI-05-0838.
Two of the most common types of health care delivery systems in the U.S. are fee-for-service (FFS) and managed care systems such as health maintenance organizations (HMO). Differences may exist in patient outcomes depending on the health care delivery system in which they are enrolled. We evaluated differences in the survival of patients with breast and colorectal cancer at diagnosis between the two Medicare health care delivery systems (FFS and HMO).
We used a linkage of two national databases, the Medicare database from the Centers for Medicare and Medicaid Services, and the National Cancer Institute's Surveillance, Epidemiology, and End Results program database, to evaluate differences in demographic data, stage at diagnosis, and survival between breast and colorectal cancer over the period 1985 to 2001.
Medicare patients enrolled in HMOs were diagnosed at an earlier stage of diagnosis than FFS patients. HMO patients diagnosed with breast and colorectal cancer had improved survival, and these differences remained even after controlling for potential confounders (such as stage at diagnosis, age, race, socioeconomic status, and marital status). Specifically, patients enrolled in HMOs had 9% greater survival in hazards ratio if they had breast cancer, and 6% if they had colorectal cancer.
Differences exist in survival among patients in HMOs compared with FFS. This is likely due to a combination of factors, including but not limited to, earlier stage at the time of diagnoses.
美国两种最常见的医疗保健提供系统是按服务收费（FFS）和管理式医疗系统，如健康维护组织（HMO）。患者的治疗结果可能因所登记的医疗保健提供系统而异。我们评估了两种医疗保险医疗保健提供系统（FFS和HMO）中乳腺癌和结直肠癌患者诊断时的生存差异。
我们使用了两个国家数据库的链接，即医疗保险和医疗补助服务中心的医疗保险数据库以及美国国家癌症研究所的监测、流行病学和最终结果计划数据库，来评估1985年至2001年期间乳腺癌和结直肠癌患者在人口统计学数据、诊断阶段和生存方面的差异。
参加HMO的医疗保险患者比FFS患者在更早的诊断阶段被确诊。被诊断患有乳腺癌和结直肠癌的HMO患者生存率有所提高，即使在控制了潜在混杂因素（如诊断阶段、年龄、种族、社会经济地位和婚姻状况）后，这些差异仍然存在。具体而言，参加HMO的乳腺癌患者风险比生存率高9%，结直肠癌患者高6%。
与FFS相比，HMO患者的生存率存在差异。这可能是多种因素共同作用的结果，包括但不限于诊断时处于更早阶段。
