Minorities in HMOs Less Likely to Receive Colon Cancer Surveillance

SAN DIEGO—Despite 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 shouldn’t 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 CT scan).

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 treatment—race 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 we’re not doing a good job of explaining why they need follow-up care. Maybe there are cultural issues and they don’t trust us. It’s 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.”