Stage at diagnosis of breast cancer. Comparison in a fee-for-service and health maintenance organization practice.

This study assessed the effectiveness of two types of health plans in the diagnosis of female breast cancer by comparing the clinical stage at final diagnosis. Data on 202 cases diagnosed over a 4-year period from May 1983 to May 1987 were abstracted from medical records. Of these, 133 (65.8%) used fee-for-service (FFS) and 69 (34.2%) used health maintenance organization (HMO) plans. The two groups differed significantly on age and employment status; the HMO cases were younger than the FFS cases and were more likely to be employed. HMO cases also were more likely to have had some tests and procedures, but the test results were similar. Other demographic, risk factor, behavioral, clinical, and laboratory findings did not differ significantly by health plan, suggesting a uniformity of characteristics and of service availability. Overall, there was no difference between the groups in clinical stage of breast cancer at final diagnosis. On age-specific tests, however, the 45 to 55 year age group showed a significant difference in the stage of breast cancer at diagnosis with a higher proportion of HMO cases diagnosed at stage 1 than FFS cases. In contrast, in the 20 to 44 year age group, there was a nonsignificant trend for more FFS than HMO cases to be diagnosed at stage 1. Results from this study suggest that when offered by one medical practice, both FFS and HMO plans may be equally effective in the detection of breast cancer.