Affiliations of authors: Department of Health Care Policy, Harvard Medical School, Boston, MA (JZA, BEL, AMZ, JPN); Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (JZA); Department of Health Policy and Management, Harvard School of Public Health, Boston, MA (JZA, JPN); Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (BEL); Harvard Kennedy School, Cambridge, MA (JPN); National Bureau of Economic Research, Cambridge, MA (JPN; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (JZA).
J Natl Cancer Inst. 2013 Dec 18;105(24):1891-6. doi: 10.1093/jnci/djt333. Epub 2013 Dec 6.
Breast cancer is a leading cause of mortality for women in all racial/ethnic groups. We compared use of mammography by race/ethnicity in Medicare health maintenance organizations (HMOs), preferred provider organizations (PPOs), and traditional Medicare.
We matched 495 836 women in HMOs and 81 480 women in PPOs who were aged 65 to 69 years during 2009 to women enrolled in traditional Medicare by race/ethnicity, Medicaid eligibility status, and geographic area. We identified mammography use from the Healthcare Effectiveness Data and Information Set for Medicare HMOs and PPOs and from claims data for traditional Medicare with the same specifications. We then compared racial/ethnic differences in rates of mammography in HMOs and PPOs to matched populations in traditional Medicare and estimated differences with z tests. All statistical tests were two-sided.
Relative to matched white women, mammography rates were statistically significantly higher for black, Hispanic, and Asian/Pacific Islander women in HMOs (6.1, 5.4, and 0.9 percentage points, respectively; all P ≤ .003) and statistically significantly lower for all three groups in traditional Medicare (3.3, 7.4, and 7.7 percentage points, respectively; all P < .001). Similar improvements in mammography rates also were observed in PPOs among all minority groups relative to traditional Medicare.
Higher rates of mammography in HMOs and PPOs were associated with a reversal of racial and ethnic differences observed in traditional Medicare. These differences may be related to lower patient cost-sharing and better systems to promote preventive services in managed care plans, as well as unmeasured characteristics or beliefs of minority women who enroll in these health plans relative to those in traditional Medicare.
乳腺癌是所有种族/族裔女性死亡的主要原因。我们比较了医疗保险医疗保健组织（HMO）、首选提供组织（PPO）和传统医疗保险中种族/族裔的乳房 X 光检查使用率。
我们将年龄在 65 至 69 岁的 495836 名 HMO 妇女和 81480 名 PPO 妇女与按种族/族裔、医疗补助资格状况和地理区域与传统医疗保险相匹配的妇女相匹配。我们从医疗保险 HMO 和 PPO 的医疗保健效果数据和信息集以及传统医疗保险的索赔数据中确定乳房 X 光检查的使用情况，使用相同的规格。然后，我们比较了 HMO 和 PPO 中各族裔/族裔妇女的乳房 X 光检查率与传统医疗保险相匹配人群的差异，并使用 z 检验估计差异。所有统计检验均为双侧检验。
与白人相匹配的女性相比，HMO 中黑人、西班牙裔和亚洲/太平洋岛民女性的乳房 X 光检查率统计上显著更高（分别为 6.1、5.4 和 0.9 个百分点；所有 P 值均≤0.003），而传统医疗保险中所有三个组的乳房 X 光检查率统计上显著更低（分别为 3.3、7.4 和 7.7 个百分点；所有 P 值均<0.001）。在 PPO 中，与传统医疗保险相比，所有少数群体的乳房 X 光检查率也有所提高。
HMO 和 PPO 中更高的乳房 X 光检查率与传统医疗保险中观察到的种族和族裔差异的逆转有关。这些差异可能与管理式医疗计划中患者分担成本较低和促进预防性服务的更好系统有关，也可能与选择参加这些健康计划而不是传统医疗保险的少数族裔女性的未测量特征或信念有关。
