Disenrollment from Medicare managed care among beneficiaries with and without a cancer diagnosis.
Disenrollment from Medicare managed care among beneficiaries with and without a cancer diagnosis.
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有或没有癌症诊断的受益人退出医疗保险管理式护理。
DOI：
10.1093/jnci/djn208
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Schrag,Deborah
中科院分区：
文献类型：
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作者：
Elkin,ElenaB;Ishill,Nicole;Riley,GeraldF;Bach,PeterB;Gonen,Mithat;Begg,ColinB;Schrag,Deborah
医疗保险管理式医疗可以为投保人提供更低的自付费用，并提供传统的按服务收费的医疗保险计划所没有的福利。然而，管理式护理计划也可能限制提供者的选择，以努力控制成本。我们比较了在有和没有癌症诊断的医疗保险管理医疗参保人中，自愿退出医疗保险管理医疗和传统的按服务收费医疗的比率。方法：我们从1995年1月1日至2002年12月31日，在与医疗保险登记档案相关的监测、流行病学和最终结果（SEER）癌症登记记录中，选取年龄在65岁或以上的医疗保险管理医疗登记患者，诊断为原发性乳腺癌（n = 28331）、结直肠癌（n = 26494）、前列腺癌（n = 29046）或肺癌（n = 32443）。癌症患者与无癌症患者按年龄、性别、种族和地理位置配对。我们使用Cox比例风险回归估计了每位癌症患者诊断后2年内自愿退出按服务收费的医疗保险的比率，并根据计划特征和医疗保险管理的医疗普及率进行了调整。结果在诊断后2年内，癌症患者退出医疗保险管理医疗的可能性低于与其匹配的无癌症患者（乳腺癌，退出医疗保险的调整风险比[HR] = 0.78, 95%可信区间[CI] = 0.74 ~ 0.82；结直肠癌，HR = 0.84, 95% CI = 0.80 ~ 0.88；前列腺癌，HR = 0.86, 95% CI = 0.82 ~ 0.90；肺癌，HR = 0.81, 95% CI = 0.76 ~ 0.86）。不同年龄、性别、种族、SEER登记和癌症分期的结果一致。结论1995年至2002年间的新癌症诊断并没有促使人们自愿退出医疗保险管理医疗，转而选择传统的按服务收费的医疗保险。
BackgroundMedicare managed care may offer enrollees lower out-of-pocket costs and provide benefits that are not available in the traditional fee-for-service Medicare program. However, managed care plans may also restrict provider choice in an effort to control costs. We compared rates of voluntary disenrollment from Medicare managed care to traditional fee-for-service Medicare among Medicare managed care enrollees with and without a cancer diagnosis.MethodsWe identified Medicare managed care enrollees aged 65 years or older who were diagnosed with a first primary breast (n = 28 331), colorectal (n = 26 494), prostate (n = 29 046), or lung (n = 31 243) cancer from January 1, 1995, through December 31, 2002, in Surveillance, Epidemiology, and End Results (SEER) cancer registry records linked with Medicare enrollment files. Cancer patients were pair-matched to cancer-free enrollees by age, sex, race, and geographic location. We estimated rates of voluntary disenrollment to fee-for-service Medicare in the 2 years after each cancer patient’s diagnosis, adjusted for plan characteristics and Medicare managed care penetration, by use of Cox proportional hazards regression.ResultsIn the 2 years after diagnosis, cancer patients were less likely to disenroll from Medicare managed care than their matched cancer-free peers (for breast cancer, adjusted hazard ratio [HR] for disenrollment = 0.78, 95% confidence interval [CI] = 0.74 to 0.82; for colorectal cancer, HR = 0.84, 95% CI = 0.80 to 0.88; for prostate cancer, HR = 0.86, 95% CI = 0.82 to 0.90; and for lung cancer, HR = 0.81, 95% CI = 0.76 to 0.86). Results were consistent across strata of age, sex, race, SEER registry, and cancer stage.ConclusionA new cancer diagnosis between 1995 and 2002 did not precipitate voluntary disenrollment from Medicare managed care to traditional fee-for-service Medicare.