USE OF CANCER SCREENING IN A MANAGED CARE ENVIRONMENT

管理式护理的发展对癌症筛查的利用具有重要意义。先前的研究表明，保险覆盖的类型是癌症筛查使用的重要预测因素，然而这些研究使用的数据来自20世纪90年代初，当时新型管理式医疗计划尚未普及。因此，重要的是检查反映当今卫生保健环境的筛查利用的最新数据，并探索健康计划和管理护理环境的哪些特征影响筛查。本研究将探讨健康保险计划的特定特征和管理护理环境是否会影响乳腺癌、宫颈癌和前列腺癌筛查的使用。我们不只是比较“管理式医疗”与按服务收费计划的利用率，而是分析不同类型计划的具体特征，如提供的福利、初级保健看门人的使用以及参保人对提供者选择的程度。这些特征，而不是一个计划是否被标记为“管理式医疗”，最有可能影响筛查的利用。我们将使用医疗支出小组调查的数据，这是一项由卫生保健政策和研究机构进行的具有全国代表性的调查。MEPS不仅从患者个人那里获取数据，还从他们的保险公司那里获取数据，这扩大并验证了个人的保险报告。此外，通过将MEPS数据与我们自己的环境特征数据库联系起来，我们将能够检查管理医疗环境的特征，如HMO市场份额、竞争和HMO活动的其他指标是否会影响利用率。我们还将研究当前管理护理背景下癌症筛查利用的模式；制定一个概念框架；检查患者、提供者、计划和环境因素的相对影响；并与凯撒医疗机构合作开展一项关于自我报告前列腺癌筛查准确性的研究。检查影响使用率的因素对于了解当前管理式护理环境对获取、结果和护理质量的影响非常重要。因此，研究结果不仅对本研究中检查的筛查类型有影响，而且对其他卫生保健服务也有影响。

The growth of managed care has important implications for cancer screening utilization. Previous studies demonstrated that the type of insurance coverage is an important predictor of the use of cancer screening, yet these studies were conducted using data from the early 1990's before the proliferation of new types of managed care plans. It is therefore important to examine recent data on screening utilization that reflects today's health care environment, and to explore what features of health plans and the managed care environment influence screening. This study will examine whether specific characteristics of health insurance plans and the managed care environment influence utilization of breast, cervical, and prostate cancer screening. Rather than only comparing utilization in "managed care" vs. fee-for-service plans, we will analyze specific characteristics across types of plans such as the benefits provided, use of primary care gatekeepers, and the extent of enrollees' provider choice. These characteristics, rather than whether a plan is labeled "managed care", are most likely to influence screening utilization. We will use data from the Medical Expenditure Panel Survey, a nationally representative survey conducted by the Agency for Health Care Policy and Research. The MEPS obtains data not only from individual patients but also from their insurers, which expands and validates individuals' reports of coverage. Furthermore, by linking MEPS data with our own database of environmental characteristics, we will be able to examine whether characteristics of the managed care environment such as HMO market share, competition, and other measures of HMO activity influence utilization. We will also examine patterns of cancer screening utilization in the current managed care context; develop a conceptual framework; examine the relative influence of patient, provider, plan, and environmental factors; and conduct a study of the accuracy of self-reported prostate cancer screening in collaboration with Kaiser Permanente. Examining the factors that influence utilization is important for understanding the impact of the current managed care environment on access, outcomes, and quality of care. The findings will therefore have implications not only for the types of screening examined in this study but also for other health care services.