BREAST-CANCER-TREATMENT CHOICE AND MASTECTOMY LENGTH OF STAY - A COMPARISON OF HMO AND OTHER PRIVATELY INSURED WOMEN

This study uses hospital discharge abstract data from five states (Mas sachusetts, New York, New Jersey, Maryland, and California) for two ye ars (1988 and 1991) to investigate whether enrollment in an HMO affect s nonelderly breast cancer patients' treatment choice (breast-conservi ng surgery or mastectomy) and hospital length of stay for women who ha ve a mastectomy. Since HMO insurance creates financial incentives that differ from other types of insurance coverage, it is important to ass ess whether the type of insurance coverage affects the care received b y breast cancer patients. Although the results vary from state to stat e, they suggest that HMO enrollees are less likely to receive breast-c onserving surgery (relative odds = .93). However, an unambiguous inter pretation of this finding requires better data on patients' opportunit y costs and preferences, which also may vary with type of insurance co verage. Among women who had a mastectomy, HMO enrollment was generally associated with a 4.5% shorter average length of stay and a greater l ikelihood of a short stay (one or two days, relative odds = 1.21-1.29) . A much higher proportion of mastectomy patients in California than i n other states had a short stay. Follow-up of these women may indicate whether short stays lead to adverse long-term health effects.