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Study: HMO breast cancer care similar to traditional insurance


From Senior CNN Medical Correspondent Dan Rutz

ATLANTA (CNN) -- A new study of older women with breast cancer shows managed care programs compare favorably with traditional insurance programs in diagnosing and treating the disease.

In a general comparison, the study found health maintenance organizations, or HMOs, diagnosed breast cancer sooner and often at an earlier stage than traditional insurance companies.

"The stage of diagnosis is a very important predictor of survival," said Gerald Riley of the Health Care Financing Administration. "The earlier that the cancer can be detected the better the woman's chances of being cured of the disease."

A study in the Journal of the American Medical Association compares the experiences of thousands of elderly breast cancer patients in Medicare HMOs with those on standard Medicare insurance.

The HMO group tended to be about a year younger when their breast cancer was found, though first-line treatment varied little according to the insurance type.

HMO participants were only slightly more likely to undergo breast conserving lumpectomy operations instead of mastectomy, where the entire breast is removed. However, HMO patients who had the lesser surgery were far more likely to receive radiation treatment.

Radiation treatment is usually recommended following lumpectomy. Some HMO critics have worried that, with the emphasis on economy, HMOs might cut corners on care, a fear not borne out by this study.

"We found no evidence that this is a systematic problem, most of the plans that we looked at provided levels of radiation therapy similar to those provided in fee-for-service, or provided more," Riley said.

The overview also revealed a lot of variation among specific insurance plans of both types. Cancer screening and treatment policies varied greatly, by region, education level and age of patient.

Families USA, an advocacy group sometimes critical of HMOs, said the study underscores their argument for laws setting standards for all HMOs to meet.

"We do have concern, however, that we hear that some plans really do cut corners -- that they do not provide services people think they really need, and that is why we support uniform rules that should apply to all HMOs," said Families USA Director of Governmental Affairs Judy Waxman.

Even with government safeguards, the study shows patients need to stay on their toes on matters of health. Experts say being informed helps in choosing the best insurance plans and assuring patients get the care they need.

SPECIAL: The HMO debate
The people vs. HMOs
January 25, 1999
Doctors warn against campaign to reduce Caesarean births
January 6, 1999
Study identifies best managed care practices for breast cancer
August 19, 1998

Journal of the American Medical Association
Health Care Financing Administration
Families USA
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