SAN DIEGODespite the egalitarian nature of health maintenance
organizations (HMOs), minority and low-income patients enrolled in
such plans may not receive the same colorectal cancer surveillance
care as whites and higher income patients.
Tamir Ben-Menachem, MD, director of endoscopy, Henry Ford Hospital,
Detroit, and Jennifer Elston-Lafata, PhD, director of the Center for
Health Services Research, reported these findings at the American
Gastro-enterological Association (AGA) annual meeting, held during
the Digestive Disease Week conference.
Dr. Ben-Menachem and his colleagues decided to take a look at HMO
population care after reading reports that colorectal cancer
screening rates are lower in minority Medicare patients. We
sought to find out if patients in a full-service HMO environment
received similar post-treatment surveillance care, he said.
With full coverage, money shouldnt be an issue.
The researchers utilized a 500,000-member cancer registry and
identified HMO patients diagnosed with stage I, II, or III colorectal
cancer between 1990 and 1995. Claims data were used to gather
information about the frequency and timing of tests used to detect
local recurrence (colonoscopy, sigmoidoscopy, and air contrast barium
enema) or metasta-ses (CEA, liver enzyme, chest x-ray, bone scan, and
A total of 251 patients with an average age of 65 were studied from
the time of treatment until recurrence, death, or disenrollment from
the HMO, or until the end of 1997. Of these patients, 63% were white,
34% were black, and 62% were men. Dr. Ben-Menachem said that the
rates of local recurrence, metastatic disease, and mortality were
similar among the various demographic groups.
A complete examination of the colon was performed in 49% of all
patients at the 1-year mark, and in 78% by 5 years. Younger patients,
whites, and higher-income patients were more likely to receive a
complete colon examination than were older patients, blacks, or
patients with lower incomes.
The average cost of medical care per patient over the 8-year
follow-up period was $35,441 for whites and $24,299 for blacks.
There were two major differences we found between how patients
received treatmentrace and median income, Dr. Ben-Menachem
said. We were a little surprised. Despite equal health care
coverage and equal access to physicians, patients were not utilizing
the same ser-vices. Perhaps were not doing a good job of
explaining why they need follow-up care. Maybe there are cultural
issues and they dont trust us. Its a tough question to answer.
Drs. Ben-Menachem and Elston-Lafata further commented that there
is much we still do not know about why these differences exist for
both HMO and Medicare patients. Research to help us understand this
important question is currently underway at Henry Ford Hospital.