Chirikos Thomas N, López-Garcia Josefina, Cintrón Vargas Cristóbal, Gonzalez Omayra L, Pérez-Grau Maria P, Baez-Diaz Luis
H. Lee Moffitt Cancer Center & Research Institute at the University of South Florida, USA.
J Health Care Poor Underserved. 2007 Feb;18(1):116-38. doi: 10.1353/hpu.2007.0006.
Puerto Rico has implemented Health Care Reform legislation that shifted medically indigent and underserved persons from direct care by public sector institutions to managed care arrangements through the private sector. Our aim is to assess how previously underserved women with breast cancer have fared during the first three years of the Reform. Medical claims data were obtained on breast cancer cases in San Juan who were either enrolled in the capitated Reform plan or in a commercial policy offered by the same insurer. A set of indicators reflecting initial therapy, use of key services, and cumulative utilization rates of various medical procedures were constructed. Statistical tests were conducted to assess whether these indicators differed between Reform- and commercially-insured patients. Failure to reject null hypotheses of indicator differences were then used to judge Reform progress. We found some differences, but they were neither pervasive nor unidirectional. On balance, we conclude that previously underserved women are being treated for breast cancer roughly on par with other patients. This conclusion, however, is preliminary and subject to important qualifications.
波多黎各实施了医疗保健改革立法，将医疗贫困和服务不足的人群从公共部门机构的直接护理转移到通过私营部门的管理式护理安排。我们的目的是评估以前服务不足的乳腺癌女性在改革的头三年里的情况。我们获取了圣胡安乳腺癌病例的医疗理赔数据，这些病例要么参加了按人头付费的改革计划，要么参加了同一家保险公司提供的商业保险。构建了一组反映初始治疗、关键服务使用情况以及各种医疗程序累计使用率的指标。进行了统计测试，以评估这些指标在参加改革计划的患者和商业保险患者之间是否存在差异。未能拒绝指标差异的零假设随后被用来判断改革进展。我们发现了一些差异，但这些差异既不普遍也不是单向的。总体而言，我们得出结论，以前服务不足的女性接受乳腺癌治疗的情况大致与其他患者相当。然而，这一结论是初步的，且有重要的限定条件。
