A major aspect of current health care reform proposals in the U.S. is the increased use of capitation payment and greater reliance on health maintenance organizations (HMOs). This study proposes to investigate the effect of two economic (health-care related) predictor variables, namely health insurance status and delivery system, on three outcomes measures for female breast cancer and colorectal cancer: extent of disease at diagnosis (includes stage, size of tumor, number of positive lymph nodes), treatment modality selected, and survival rates. The health insurance status variable encompasses both HMO and non-HMO health plans. Delivery system variables include small community, large community, rural, teaching, HMO hospitals, and clinics. Other patient variables to be considered include age, histologic type, race/ethnicity, marital status, nativity, income, education, family size, year of diagnosis, sex, and location of tumor. The study employs methods of biostatistics econometrics, and epidemiology to investigate these variables in a cohort of approximately 3,800 of female breast cancers and 2,940 colorectal cancers diagnosed between 1987 and 1993 in a population of approximately 2.54 million northern California residents. Cases are to be identified through a population- based cancer registry, part of the California statewide cancer registry system. A comparison of uninsured vs insured patients will indicate the effect of universal insurance coverage on prevention, treatment, and survival. A comparison of HMO vs. non-HMO insurance will indicate the effects of the growth in managed care over the past decade. It is hoped that this study will add to our limited knowledge in a competitive health care environment where quality and outcome measures will be increasingly important. This study can provide information regarding extent of disease, treatment modalities, and survival to be used in evaluating health care delivery systems, with their varying provider incentives. Delivery systems can also use these results for their """"""""report cards"""""""", allowing potential purchasers of their services to make informed choices.
| Lee-Feldstein, Anna; Feldstein, Paul J; Buchmueller, Thomas (2002) Health care factors related to stage at diagnosis and survival among Medicare patients with colorectal cancer. Med Care 40:362-74 |
| Lee-Feldstein, A; Feldstein, P J; Buchmueller, T et al. (2001) Breast cancer outcomes among older women: HMO, fee-for-service, and delivery system comparisons. J Gen Intern Med 16:189-99 |
| Lee-Feldstein, A; Feldstein, P J; Buchmueller, T et al. (2000) The relationship of HMOs, health insurance, and delivery systems to breast cancer outcomes. Med Care 38:705-18 |
