Management of colorectal cancer in medicare health maintenance organizations

Abstract

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 bad fecal occult blood tests (74% vs 52%, p<0.01) and endoscopy or barium enemas (97% vs 90%, p<0.05). FFS patients were more likely to have had preoperative imaging studies (54% vs 38%, p<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.