Cost Containment and Initiation of Care for Cancer in a Medicare-Eligible Population.

This article focuses on cost containment and initiation of care for cancer in a medicare-eligible population. Providing quality health care to the elderly while containing costs has become a key policy dilemma for the Social Security system. To contain costs, the federal government has often considered encouraging medicare beneficiaries to join Health Maintenance Organizations (HMOs) and requiring them to pay a higher percentage of the charges for their care. Supporters of HMOs argue that these organizations, free from the temptation in fee-for-service settings to provide more services than necessary, deliver care more economically. Investigations in both the United States and Canada indicate that copayment significantly reduces utilization of services, while a broad range of research studies suggests that lack of disposable income and inadequate insurance coverage cause at least some individuals to forego necessary care. These findings raise issues about possible impacts of recent cost-containment proposals on the quality of care received by Medicare beneficiaries with limited resources and progressive, life-threatening illnesses.