The Relationship of HMOs, Health Insurance, and Delivery Systems to Breast Cancer Outcomes
Medical CarePublished 1 July 2000
Anna Lee‐Feldstein, Paul J. Feldstein, Thomas C. Buchmueller, Gale Katterhagen
Citations56
SJR quartileQ1
SJR score1.57
SNIP1.38
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TL;DR
Group-model and nongroup-model HMO patients are similar to FFS-insured patients in stage at diagnosis and survival outcomes, and treatment selection is related to hospital type rather than insurance coverage.
Abstract
Group-model and nongroup-model HMO patients are similar to FFS-insured patients in stage at diagnosis and survival outcomes. Treatment selection is related to hospital type rather than insurance coverage.
Keywords
MedicineEconomics, Econometrics and Finance
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