Survival and treatment for colorectal cancer medicare patients in two group staff health maintenance organizations and the fee-for-service setting

The current study compares treatment use and long-term survival in colorect al cancer patients between Medicare beneficiaries enrolled in two large pre paid group/study health maintenance organizations (HMOs) and the fee-for-se rvice (FFS) setting. The study is based on 15,352 colorectal cancer cases d iagnosed between 1985 and 1992 and followed through 1995. Survival differen ces between the HMO and FFS cases were assessed using Cox regression. Treat ment differences were evaluated using logistic regression. HMO cases had a lower overall mortality than did FFS cases but not a significantly lower co lorectal cancer-specific mortality. Use of surgical resection was similar b etween HMO and FFS cases. However, rectal cancer cases in the HMOs were mor e likely to receive postsurgical radiation therapy than FFS cases. Superior overall survival in the HMOs may be the result of increased colorectal can cer screening, greater use of adjuvant therapies, and selection of healthie r individuals.