USE OF CANCER SCREENING IN A MANAGED CARE ENVIRONMENT

管理型医疗服务的增长对癌症筛查的利用具有重要影响。以前的研究表明，保险范围的类型是癌症筛查使用的重要预测因素，但这些研究是在新型管理型医疗计划激增之前使用1990年代初S的数据进行的。因此，重要的是要检查反映当今卫生保健环境的筛查利用的最新数据，并探索卫生计划和管理保健环境的哪些特征影响筛查。这项研究将检验健康保险计划的特定特征和管理式医疗环境是否会影响乳腺癌、宫颈癌和前列腺癌筛查的使用。我们将分析不同类型的计划的具体特征，如提供的福利、初级保健看门人的使用以及参保人选择提供者的程度，而不是只比较“管理式医疗”和“按服务收费”计划的利用率。最有可能影响筛查利用率的是这些特征，而不是计划是否被标记为“管理性医疗”。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。欧洲议会议员不仅从个别患者那里获得数据，还从他们的保险公司那里获得数据，这将扩大和验证个人的保险报告。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、竞争和其他HMO活动指标是否影响利用率。我们还将研究当前管理医疗环境下癌症筛查利用的模式；开发概念框架；检查患者、提供者、计划和环境因素的相对影响；并与Kaiser Permanente合作开展一项关于自我报告前列腺癌筛查的准确性的研究。检查影响利用率的因素对于理解当前管理式医疗环境对获取、结果和医疗质量的影响是重要的。因此，这些发现不仅对这项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.