Managed care enrollment and chronically disabled women with breast cancer

Objective: To assess whether managed care enrollment or healthcare utilization level among women enrolled in Medicare because of disability affects stage at diagnosis and treatment of breast cancer. Study Design: Retrospective study using the Surveillance, Epidemiology, and End Results Medicare database. We compared breast cancer stage at diagnosis and treatment among women with disabilities enrolled in Medicare managed care versus fee-for-service (FFS) Medicare. Women enrolled in FFS Medicare were classified into levels of healthcare utilization during the 6 to 18 months before breast cancer diagnosis. Methods: Controlling for confounders, we used regression models to determine the effects of managed care enrollment and healthcare utilization level on earlier stage at diagnosis and treatment of breast cancer. Results: Disabled patients enrolled in FFS Medicare without contact with the healthcare system and those with fewer than 12 physician visits during the 6 to 18 months before breast cancer diagnosis were more likely than disabled patients enrolled in Medicare managed care to be diagnosed as having breast cancer at a late stage. There was no difference between women enrolled in Medicare managed care versus women enrolled in FFS Medicare having at least 12 physician visits during the 12-month period. Breast cancer treatment for women with disabilities did not vary across managed care enrollment or healthcare utilization level. Conclusion: Managed care enrollment or increased contact with healthcare providers could result in earlier stage at breast cancer diagnosis.