This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (3)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Medical Practice, Other  • Neoplasms  • Alert me on articles by topic

Robert S. Kirsner, MD, PhD; James D. Wilkinson, MD, MPH; Fangchao Ma, MD, PhD; Heather Pacheco, MD; Daniel G. Federman, MD

Arch Dermatol. 2005;141:753-757.

Objective  To evaluate differences in the stage at diagnosis and survival for melanoma between the 2 most common types of Medicare health care delivery systems, fee-for-service (FFS) and managed care (health maintenance organizations [HMOs]), in the United States during the period from January 1, 1985, through December 31, 1994.

Design  We used a linkage of 2 national databases, ie, the Medicare database from the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) and the National Cancer Institute Surveillance, Epidemiology, and End Results program database, to evaluate differences in demographic data, stage at diagnosis, and survival for melanoma between the HMO and FFS groups.

Patients  A population of 4608 patients (62% men; 92% white).

Results  We found an earlier stage of diagnosis for the HMO group compared with the FFS group for melanoma as the first cancer diagnosis, but this did not persist when melanoma was the second or a later cancer diagnosis. For patients with melanoma as the first cancer diagnosis, improved survival was related to earlier stage at diagnosis.

Conclusions  Differences exist in stage at diagnosis between patients in HMOs compared with those in FFS health care plans. This is likely due in part to utilization of services or access to care for patients in HMOs, and may be similar to that of patients in FFS plans with a previous cancer diagnosis before their diagnosis of melanoma. We did not find an increased risk of diagnosis with a late-stage cancer among patients with vs those without a previous cancer diagnosis. Improved survival appears to be related to earlier stage at diagnosis.

Author Affiliations: Departments of Epidemiology and Public Health (Drs Kirsner and Wilkinson) and Dermatology and Cutaneous Surgery (Drs Kirsner, Ma, and Pacheco) and Sylvester Comprehensive Cancer Center (Dr Kirsner), University of Miami School of Medicine, and Department of Dermatology, Veterans Affairs Medical Center (Dr Kirsner), Miami, Fla; and Division of General Medicine, Veterans Affairs Medical Center (Dr Federman), and Department of Internal Medicine, Yale University School of Medicine (Dr Federman), West Haven, Conn.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Melanoma Outcomes for Medicare Patients: Association of Stage and Survival With Detection by a Dermatologist vs a Nondermatologist
Pennie et al.
Arch Dermatol 2007;143:488-494.
ABSTRACT | FULL TEXT  

Effect of Health Care Delivery Models on Melanoma Thickness and Stage in a University-Based Referral Center: An Observational Pilot Study
Swetter et al.
Arch Dermatol 2007;143:30-36.
ABSTRACT | FULL TEXT  

Ethnic differences among patients with cutaneous melanoma.
Cormier et al.
Arch Intern Med 2006;166:1907-1914.
ABSTRACT | FULL TEXT