Delay in gynecologic surgical treatment: a comparison of patients in managed care and fee-for-service plans

Abstract

Objective: To determine whether membership in a managed care organization is associated with a delay in receiving definitive surgical treatment for benign gynecologic or gynecologic oncologic diseases. Methods: Four hundred patients who had definitive surgery between 1994 and 1997 were divided into those with benign gynecologic ( n = 207) and gynecologic oncologic diagnoses ( n = 193). Each group was subdivided into managed care patients and fee-for-service patients. Subgroups were analyzed for delay in surgical treatment, emergency room visits, length of stay, age, clinic visits, prior evaluation, prior treatment, second opinions, operating room time, estimated blood loss, and surgical complications. Results: There were 122 managed care and 85 fee-for-service patients with benign gynecologic diagnoses. The time from initial presentation to the date of definitive surgery was significantly longer for the managed care patients (133.7 ± 21 days compared with 84.9 ± 12.8 days, P = .03). Of the 193 patients with gynecologic cancer 96 were in the managed care group and 97 were under fee-for-service arrangements. There was no significant difference in the time from initial presentation to the date of definitive surgery between these two groups (35.7 ± 7.4 days compared with 20.5 ± 2.5 days, P = .29). There were no significant differences between groups in emergency room or clinic visits, prior evaluations or treatments, or surgical complications when stratified by diagnosis. The mean age of managed care patients was significantly lower than that of fee-for-service patients for gynecologic diagnoses (46.4 ± 9.7 years compared with 56.5 ± 14.9 years, P < .001), and gynecologic oncologic diagnoses (47.5 ± 13.2 years compared with 60.9 ± 15.8 years, P < .001). Conclusion: Membership in a managed care organization is associated with a delay in receiving definitive surgical care for benign gynecologic, but not gynecologic oncologic, diseases.