Grant Number:	1R01CA081130-01A1 Interpret this number
Primary Investigator:	Phillips, Kathryn
Organization:	Univ Of California At San Francisco
Project Title:	Use of Cancer Screening in a Managed Care Environment
Fiscal Year:	2000

The growth of managed care has important implications for cancer screening utilization. Previous studies demonstrated that the type of insurance coverage is an important predictor of the use of cancer screening, yet these studies were conducted using data from the early 1990's before the proliferation of new types of managed care plans. It is therefore important to examine recent data on screening utilization that reflects today's health care environment, and to explore what features of health plans and the managed care environment influence screening. This study will examine whether specific characteristics of health insurance plans and the managed care environment influence utilization of breast, cervical, and prostate cancer screening. Rather than only comparing utilization in "managed care" vs. fee-for-service plans, we will analyze specific characteristics across types of plans such as the benefits provided, use of primary care gatekeepers, and the extent of enrollees' provider choice. These characteristics, rather than whether a plan is labeled "managed care", are most likely to influence screening utilization. We will use data from the Medical Expenditure Panel Survey, a nationally representative survey conducted by the Agency for Health Care Policy and Research. The MEPS obtains data not only from individual patients but also from their insurers, which expands and validates individuals' reports of coverage. Furthermore, by linking MEPS data with our own database of environmental characteristics, we will be able to examine whether characteristics of the managed care environment such as HMO market share, competition, and other measures of HMO activity influence utilization. We will also examine patterns of cancer screening utilization in the current managed care context; develop a conceptual framework; examine the relative influence of patient, provider, plan, and environmental factors; and conduct a study of the accuracy of self-reported prostate cancer screening in collaboration with Kaiser Permanente. Examining the factors that influence utilization is important for understanding the impact of the current managed care environment on access, outcomes, and quality of care. The findings will therefore have implications not only for the types of screening examined in this study but also for other health care services.




Measuring managed care and its environment using national surveys: a review and assessment.
Authors: Liang S.Y. , Phillips K.A. , Haas J.S. .
Source: Medical care research and review : MCRR, 2006 Dec; 63(6 Suppl), p. 9S-36S.
PMID: 17099128
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Out-of-pocket expenditures for oral contraceptives and number of packs per purchase.
Authors: Phillips K.A. , Stotland N.E. , Liang S.Y. , Spetz J. , Haas J.S. , Oren E. .
Source: Journal of the American Medical Women's Association (1972), 2004 Winter; 59(1), p. 36-42.
PMID: 14768985
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The effect of area HMO market share on cancer screening.
Authors: Baker L.C. , Phillips K.A. , Haas J.S. , Liang S.Y. , Sonneborn D. .
Source: Health services research, 2004 Dec; 39(6 Pt 1), p. 1751-72.
PMID: 15533185
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Variation in screening mammography and Papanicolaou smear by primary care physician specialty and gatekeeper plan (United States).
Authors: Haggstrom D.A. , Phillips K.A. , Liang S.Y. , Haas J.S. , Tye S. , Kerlikowske K. .
Source: Cancer causes & control : CCC, 2004 Nov; 15(9), p. 883-92.
PMID: 15577290
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Genetic testing and pharmacogenomics: issues for determining the impact to healthcare delivery and costs.
Authors: Phillips K.A. , Veenstra D.L. , Ramsey S.D. , Van Bebber S.L. , Sakowski J. .
Source: The American journal of managed care, 2004 Jul; 10(7 Pt 1), p. 425-32.
PMID: 15298364
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Variation in access to health care for different racial/ethnic groups by the racial/ethnic composition of an individual's county of residence.
Authors: Haas J.S. , Phillips K.A. , Sonneborn D. , McCulloch C.E. , Baker L.C. , Kaplan C.P. , Pérez-Stable E.J. , Liang S.Y. .
Source: Medical care, 2004 Jul; 42(7), p. 707-14.
PMID: 15213496
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Willingness to recommend a health plan: who is dissatisfied and what don't they like?
Authors: Sakowski J.A. , Phillips K.A. , Liang S.Y. , Haas J.S. .
Source: The American journal of managed care, 2004 Jun; 10(6), p. 393-400.
PMID: 15209483
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Does patient cost sharing matter? Its impact on recommended versus controversial cancer screening services.
Authors: Liang S.Y. , Phillips K.A. , Tye S. , Haas J.S. , Sakowski J. .
Source: The American journal of managed care, 2004 Feb; 10(2 Pt 1), p. 99-107.
PMID: 15011810
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Moving beyond the typologies of managed care: the example of health plan predictors of screening mammography.
Authors: Tye S. , Phillips K.A. , Liang S.Y. , Haas J.S. .
Source: Health services research, 2004 Feb; 39(1), p. 179-206.
PMID: 14965083
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Are gatekeeper requirements associated with cancer screening utilization?
Authors: Phillips K.A. , Haas J.S. , Liang S.Y. , Baker L.C. , Tye S. , Kerlikowske K. , Sakowski J. , Spetz J. .
Source: Health services research, 2004 Feb; 39(1), p. 153-78.
PMID: 14965082
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Is the prevalence of gatekeeping in a community associated with individual trust in medical care?
Authors: Haas J.S. , Phillips K.A. , Baker L.C. , Sonneborn D. , McCulloch C.E. .
Source: Medical care, 2003 May; 41(5), p. 660-8.
PMID: 12719690
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Effect of managed care insurance on the use of preventive care for specific ethnic groups in the United States.
Authors: Haas J.S. , Phillips K.A. , Sonneborn D. , McCulloch C.E. , Liang S.Y. .
Source: Medical care, 2002 Sep; 40(9), p. 743-51.
PMID: 12218765
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Potential role of pharmacogenomics in reducing adverse drug reactions: a systematic review.
Authors: Phillips K.A. , Veenstra D.L. , Oren E. , Lee J.K. , Sadee W. .
Source: JAMA, 2001-11-14; 286(18), p. 2270-9.
PMID: 11710893
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Barriers to care among racial/ethnic groups under managed care.
Authors: Phillips K.A. , Mayer M.L. , Aday L.A. .
Source: Health affairs (Project Hope), 2000 Jul-Aug; 19(4), p. 65-75.
PMID: 10916961
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