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Sheldon M. Retchin, MD, MSPH

JAMA. 1999;281:755-756.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

With encouragement from the federal government, there has been steady growth in the number of Medicare beneficiaries enrolled in health maintenance organizations (HMOs) during the past 2 decades.¹ The Balanced Budget Act of 1997 has further expanded managed care alternatives through the establishment of the Medicare+Choice program, and HMO enrollment may be one third of the Medicare population by 2005.² However, thus far, the overall assessment about the quality of care in Medicare HMOs has been inconclusive.³

In this issue of THE JOURNAL, Riley et al⁴ report that elderly women with breast cancer were more likely to receive recommended diagnostic and therapeutic interventions in Medicare HMOs compared with similar fee-for-service settings. This study also found substantial performance variations among the HMOs, including both favorable and unfavorable patterns of care. Contributory factors to these performance differences could derive from recent changes in the health care marketplace . . . [Full Text of this Article]

Author Affiliation: Department of Internal Medicine, Virginia Commonwealth University, Richmond.

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Stage at Diagnosis and Treatment Patterns Among Older Women With Breast Cancer: An HMO and Fee-for-Service Comparison
Gerald F. Riley, Arnold L. Potosky, Carrie N. Klabunde, Joan L. Warren, and Rachel Ballard-Barbash
JAMA. 1999;281(8):720-726.
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