OBJECTIVE: Two common health care delivery systems in the United States are fe e-for-service and managed care systems, including health maintenance organizat ions (HMOs). Differences may exist in patient outcomes depe...OBJECTIVE: Two common health care delivery systems in the United States are fe e-for-service and managed care systems, including health maintenance organizat ions (HMOs). Differences may exist in patient outcomes depending upon the health care delivery system in which they are enrolled. We evaluated possible differen ces in the stage at diagnosis for breast and cervical cancer between 2 Medicare health care delivery systems (ie, fee for service and HMO) over the period 1985 -2001. METHODS: We used a linkage of 2 national databases: the Medicare databas e from the Centers for Medicare and Medicaid Services and the National Cancer In stitute’s Surveillance, Epidemiology, and End Results program database to evalu ate differences in stage at diagnosis between HMO and fee for service for breast and cervical cancer. RESULTS: We studied 130,336 Medicare-aged women with brea st cancer (83%Medicare fee for service) and 6,758 women with cervical cancer (8 7%Medicare fee for service). We found an earlier stage of diagnosis for HMO pat ients, which remained significant after adjusting for potential confounding vari ables. Women enrolled in HMOs with breast cancer were 17%more likely and those with cervical cancer 35%more likely to be diagnosed at an in situ stage of diag nosis than fee-for-service patients. It is of note that when women had other c ancer diagnoses, no statistically significant differences were seen in stage at diagnosis for either cancer between fee-for-service and HMO patients. CONCLUSI ON: Differences exist in stage at diagnosis between Medicare patients enrolled i n HMOs compared with fee for service. This is likely due in part to use of or ac cess to care.展开更多
近日,《The New England Journal of Medicine》杂志发表了题为＂International Health Care Systems＂的社论。文章指出,全球各国虽然经济、政治、文化、环境以及流行病学和人口学背景不同,但都致力于建立一个符合本国特点并满足人民...近日,《The New England Journal of Medicine》杂志发表了题为＂International Health Care Systems＂的社论。文章指出,全球各国虽然经济、政治、文化、环境以及流行病学和人口学背景不同,但都致力于建立一个符合本国特点并满足人民需求的卫生保健系统。
在卫生保健体系的建设过程中,发展中国家大多依赖社区卫生工作者,而发达国家则是医生、护士及其他卫生人员共同发挥作用。展开更多
美国卫生福利部(HHS)发言人Tommy G. Thompson近日指出,政府将分两个阶段建立国家电子卫生保健系统。该系统的建立将使患者与医生能够随时地获取所需的完整的医学病例记录,进而减少诊断错误,提高治疗水平,降低卫生保健费用。 HHS首先与...美国卫生福利部(HHS)发言人Tommy G. Thompson近日指出,政府将分两个阶段建立国家电子卫生保健系统。该系统的建立将使患者与医生能够随时地获取所需的完整的医学病例记录,进而减少诊断错误,提高治疗水平,降低卫生保健费用。 HHS首先与美国病理学会(CAP)签署一项协议。展开更多
文摘OBJECTIVE: Two common health care delivery systems in the United States are fe e-for-service and managed care systems, including health maintenance organizat ions (HMOs). Differences may exist in patient outcomes depending upon the health care delivery system in which they are enrolled. We evaluated possible differen ces in the stage at diagnosis for breast and cervical cancer between 2 Medicare health care delivery systems (ie, fee for service and HMO) over the period 1985 -2001. METHODS: We used a linkage of 2 national databases: the Medicare databas e from the Centers for Medicare and Medicaid Services and the National Cancer In stitute’s Surveillance, Epidemiology, and End Results program database to evalu ate differences in stage at diagnosis between HMO and fee for service for breast and cervical cancer. RESULTS: We studied 130,336 Medicare-aged women with brea st cancer (83%Medicare fee for service) and 6,758 women with cervical cancer (8 7%Medicare fee for service). We found an earlier stage of diagnosis for HMO pat ients, which remained significant after adjusting for potential confounding vari ables. Women enrolled in HMOs with breast cancer were 17%more likely and those with cervical cancer 35%more likely to be diagnosed at an in situ stage of diag nosis than fee-for-service patients. It is of note that when women had other c ancer diagnoses, no statistically significant differences were seen in stage at diagnosis for either cancer between fee-for-service and HMO patients. CONCLUSI ON: Differences exist in stage at diagnosis between Medicare patients enrolled i n HMOs compared with fee for service. This is likely due in part to use of or ac cess to care.
文摘近日,《The New England Journal of Medicine》杂志发表了题为＂International Health Care Systems＂的社论。文章指出,全球各国虽然经济、政治、文化、环境以及流行病学和人口学背景不同,但都致力于建立一个符合本国特点并满足人民需求的卫生保健系统。
在卫生保健体系的建设过程中,发展中国家大多依赖社区卫生工作者,而发达国家则是医生、护士及其他卫生人员共同发挥作用。
