HMO penetration and quality of care: the case of breast cancer.

In theory, health maintenance organizations (HMOs) receiving a fixed payment rate per enrolled member have an incentive to coordinate services and emphasize prevention and early detection of disease in order to minimize costs of care. This article tests whether higher HMO penetration rates across counties in the United States and across time improve the use of mammography services, the chance of early rather than late detection of breast cancer, and ultimately improve breast cancer survival. We use two data sets to test the effect of HMO penetration on use of breast cancer services and on breast cancer health outcomes for women aged 55 to 64 years. These data sources are matched with county-level data on HMO penetration and other market variables from the Bureau of Health Profession's Area Resource File. Results of logit regression show evidence that HMO penetration positively affects the probability of recent mammography receipt. However, we do not find a statistically significant relationship between HMO penetration and either stage of diagnosis or breast cancer survival.