BACKGROUND: Enrollment in health maintenance organizations (HMOs) has increased rapidly during the past 10 years, reflecting a growing emphasis on health care cost containment. To determine whether there is a difference in the treatment and outcome for female @entity1 with @entity0 enrolled in HMOs versus a fee-for-service setting, we compared the 10-year survival and initial treatment of @entity1 with @entity0 enrolled in both types of plans. METHODS: With the use of @entity5 registries covering the greater San Francisco-Oakland and Seattle-Puget Sound areas, respectively, we obtained information on the treatment and outcome for 13,358 female @entity1 with @entity0 , aged 65 years and older, diagnosed between 1985 and 1992. We linked registry information with Medicare data and data from the two large HMOs included in the study. We compared the survival and treatment differences between HMO and fee-for-service care after adjusting for @entity5 stage, comorbidity, and sociodemographic characteristics. RESULTS: In San Francisco-Oakland, the 10-year adjusted risk ratio for @entity0 among HMO @entity1 compared with fee-for-service @entity1 was 0.71 (95% confidence interval [CI] = 0.59-0.87) and was comparable for all @entity204 . In Seattle-Puget Sound, the risk ratio for @entity0 was 1.01 (95% CI = 0.77-1.33) but somewhat lower for all @entity204 . @entity1 enrolled in HMOs were more likely to receive breast-conserving surgery than @entity1 in fee-for-service (odds ratio = 1.55 in San Francisco-Oakland; 3.39 in Seattle). HMO enrollees undergoing breast-conserving surgery were also more likely to receive adjuvant radiotherapy (San Francisco-Oakland odds ratio = 2.49; Seattle odds ratio = 4.62). CONCLUSIONS: Long-term survival outcomes in the two prepaid group practice HMOs in this study were at least equal to, and possibly better than, outcomes in the fee-for-service system. In addition, the use of recommended therapy for early @entity0 was more frequent in the two HMOs.

XXXX survival and treatment in health maintenance organization and fee-for-service settings.

@entity1 :: ('9606', 'Species') :: ['women', 'patients', 'Women'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor'] @entity204 :: ('MESH:D003643', 'Disease') :: ['deaths'] @entity0 :: ('MESH:D001943', 'Disease') :: ['breast cancer', 'stage breast cancer', 'breast cancer deaths']
@entity0 :: (MESH:D001943,Disease) :: ['Breast cancer']
