Management of colorectal cancer in Medicare health maintenance organizations.

Because of the financial incentives of prepaid care, the quality of care for Medicare enrollees in Health Maintenance Organizations (HMOs) is a concern. Therefore, the care in 150 newly diagnosed cases of colorectal cancer in eight HMOs was compared with that in 180 similar fee-for-service (FFS) cases. As part of the diagnostic workup, HMO patients were more likely to have had fecal occult blood tests (74% vs 52%, p less than 0.01) and endoscopy or barium enemas (97% vs 90%, p less than 0.05). FFS patients were more likely to have had preoperative imaging studies (54% vs 38%, p less than 0.01). Although there were longer diagnostic delays for HMO enrollees with gastrointestinal bleeding, there were no significant differences in disease stage or clinical status, and postoperative follow-up was similar. The authors conclude that enrollees in Medicare HMOs with colorectal cancer receive medical and surgical care at least equal to that received in FFS settings.