Manjelievskaia Janna, Brown Derek, Shao Stephanie, Hofmann Keith, Shriver Craig D, Zhu Kangmin
John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD 20852.
Kennell and Associates, Inc., 3130 Fairview Park Drive, Suite 450, Falls Church, VA 22042.
Mil Med. 2017 Mar;182(3):e1782-e1789. doi: 10.7205/MILMED-D-16-00249.
Type of insurance and out-of-pocket costs influence the use of medical care. Specifically, type of insurance can impact an individual's likelihood of receiving a screening mammogram. Additionally, variation in tumor stage at diagnosis exists for patients with different types of insurance. It is not clear whether different benefit types and care sources differ in breast cancer care and outcomes among Department of Defense (DoD) beneficiaries.
The objective of this study was to examine differences in screening mammography and tumor stage at diagnosis between different benefit types (TRICARE Prime vs. non-Prime) and among different care sources (direct care, purchased care, and both) in the DoD Military Health System. Study subjects were women 40 to 64 years of age, diagnosed with malignant breast cancer between 2003 and 2007. Multivariable logistic regression analyses were conducted to assess differences by benefit type and care source in receipt of screening mammography before diagnosis and tumor stage at diagnosis.
A total of 2,668 women were included in this study. Patients with Prime were more likely to receive a screening mammography and have an earlier tumor stage than those with non-Prime. Women with direct care were more likely to have an earlier tumor stage but less likely to receive a screening mammogram than those with purchased care.
In an equal access health care system, the use of mammography screening and tumor stage at diagnosis may differ by benefit type and care source among DoD beneficiaries. To our knowledge, this was the first study to assess mammography screening and tumor stage differences by benefit type and care source in the Military Health System. Although underlying reasons for the differences are not clear, they may be related to out-of-pocket costs, distance from medical treatment facilities, and frequency of doctor visits for other medical problems. Further research is needed to assess these differences and related factors among DoD beneficiaries.
保险类型和自付费用会影响医疗保健的使用。具体而言，保险类型会影响个人接受乳腺钼靶筛查的可能性。此外，不同类型保险的患者在诊断时肿瘤分期存在差异。尚不清楚国防部（DoD）受益人中不同福利类型和医疗服务来源在乳腺癌护理及治疗结果方面是否存在差异。
本研究的目的是调查国防部军事医疗系统中不同福利类型（TRICARE Prime与非Prime）以及不同医疗服务来源（直接医疗、购买的医疗服务以及两者皆有）在乳腺钼靶筛查和诊断时肿瘤分期方面的差异。研究对象为2003年至2007年间被诊断为恶性乳腺癌的40至64岁女性。进行多变量逻辑回归分析，以评估福利类型和医疗服务来源在诊断前接受乳腺钼靶筛查以及诊断时肿瘤分期方面的差异。
本研究共纳入2668名女性。与非Prime的患者相比，Prime的患者更有可能接受乳腺钼靶筛查且肿瘤分期更早。与购买医疗服务的女性相比，接受直接医疗的女性肿瘤分期更早，但接受乳腺钼靶筛查的可能性更小。
在一个平等获取医疗保健的系统中，国防部受益人中乳腺钼靶筛查的使用情况和诊断时的肿瘤分期可能因福利类型和医疗服务来源而异。据我们所知，这是第一项评估军事医疗系统中福利类型和医疗服务来源在乳腺钼靶筛查和肿瘤分期方面差异的研究。尽管差异的根本原因尚不清楚，但可能与自付费用、距医疗机构的距离以及因其他医疗问题看医生的频率有关。需要进一步研究以评估国防部受益人中的这些差异及相关因素。
