Title: Cost Containment and Initiation of Care for Cancer in a Medicare-Eligible Population
Abstract: Providing quality health care to the elderly while containing costs has become a key policy dilemma for the Social Security system. To contain costs, the federal government has often considered encouraging Medicare beneficiaries to join Health Maintenance Organizations (HMOs)' and requiring them to pay a higher percentage of the charges for their care.2 Supporters of HMOs argue that these organizations, free from the temptation in fee-for-service settings to provide more services than necessary, deliver care more economically.3 Proponents of the copayment approach, in which beneficiaries pay substantial deductibles and a percentage of their covered medical expenses, contend that such arrangements motivate more prudent consumption of health services and avoidance of unnecessary physician visits and medical interventions.' Studies of HMOs and copayment plans, however, raise questions about the impacts of these and other cost control mechanisms on the quality of care. Observers such as Brown5 and Freidson6 suggest that HMO organizational structures may emphasize cost consciousness at the expense of quality consciousness. Investigations in both the United States and Canada indicate that copayment significantly reduces utilization of services,' while a broad range of research studies suggests that lack of disposable income and inadequate insurance coverage cause at least some individuals to forego necessary care.8 The research reported here examines the initiation of care for cancer, that is, the speed with which the disease is detected and treatment begun. It compares initiation of care among Medicare-eligible individuals receiving services from (1) an HMO, (2) the fee-for-service system with copayments, and (3) the fee-for-service system without copayments. Early detection and prompt treatment may both be regarded as intermediate of care, clearly capable of affecting ultimate outcomes such as survival. The discussion to follow assumes that prompt detection and treatment reflect high quality care for cancer. Other investigators have used early-stage detection of cancer as an indicator of the overall quality of ambulatory services provided by specific organizations and programs.9 The study reported below supplements previous investigations of the impacts of organization and
Publication Year: 1986
Publication Date: 1986-11-01
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 3
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