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Medicare patients with cancer don't switch from managed care to fee-for-service
More than half of all cancer diagnoses and 70 percent of all cancer deaths occur in people aged 65 years or older. Cancer patients typically require regular visits with specialists, coordination of care among multiple providers, and frequent testing to monitor disease. Even though Medicare managed care plans tend to restrict provider choice in an effort to control costs, which may not appeal to elderly patients with cancer, they do not tend to abandon managed care plans for Medicare fee-for-service (FFS), according to a new study. This might be because Medicare managed care plans offer enrollees lower out-of-pocket costs and provide benefits that are not available in the traditional FFS program, suggests Elena B. Elkin, Ph.D., of the Memorial Sloan-Kettering Cancer Center.
Dr. Elkin and colleagues identified elderly Medicare managed care enrollees who were diagnosed with primary breast, colorectal, prostate, or lung cancer from 1995 through 2002 from the Surveillance, Epidemiology, and End Results (SEER) cancer registry records linked with Medicare files. They matched cancer patients with cancer-free enrollees by age, sex, race, and geographic location.
In the 2 years after diagnosis, breast cancer patients were 22 percent less likely to disenroll from Medicare managed care than their matched cancer-free peers. Similarly, patients with colorectal, prostate, or lung cancer were also less likely to disenroll (16 percent, 14 percent, and 19 percent, respectively). These cancers are often treated by community-based physicians and do not necessarily require services available only at specialized centers. Therefore, even Medicare managed care plans that limit access to specific providers may still offer satisfactory care to patients with these common cancers. However, even Medicare patients with rarer cancers such as acute leukemia were no more likely to disenroll from managed care plans.
The study was supported in part by the Agency for Healthcare Research and Quality (HS14831).
See "Disenrollment from Medicare managed care among beneficiaries with and without a cancer diagnosis," by Dr. Elkin, Nicole Ishill, M.S., Gerald F. Riley, Ph.D., and others, in the July 16, 2008, Journal of the National Cancer Institute 100(14), pp. 1013-1021.
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