Ecologic correlates of cancer mortality patterns in an industrialized urban population.

Cancer mortality data for the period 1968-80 were analyzed to examine whether the high cancer burden for the city of Philadelphia was "evenly" distributed spatially and, if not, whether this distribution could be associated with socioeconomic variables and air pollution. Areas with significantly higher-than-expected rates tended to cluster; lung cancer and non-lung cancers showed distinctive cluster patterns, which were evident only for males; female rates for any cancer or groups of cancers were almost uniformly distributed over the neighborhoods. Both the high lung cancer and the high non-lung cancer clusters were characterized by low socioeconomic status, but only the high lung cancer clusters exhibited high levels of air pollution. These neighborhood characteristics suggested that socioeconomic variables explain non-lung cancer mortality patterns; socioeconomic variables, together with air pollution, could be responsible for the observed lung cancer patterns. The uniform distribution of female lung cancer rates suggested that air pollution by itself cannot be a prominent factor in lung cancer mortality.

Managed health care for Medicaid enrollees: the Philadelphia model.

HealthPASS, a program of capitated managed care for 82,000 Medicaid enrollees in a defined geographic area of Philadelphia, Pennsylvania, is administered by Healthcare Management Alternatives, Inc. (HMA), a minority-owned corporation, under a multiyear contract with the Commonwealth of Pennsylvania. HMA has striven to improve care to this low-income community by mounting innovative campaigns to encourage early access to health care, ongoing health education, and aggressive outreach and follow-up, in addition to specific projects designed to reduce infant mortality, expand Head Start, and bolster pediatric care. The program has been judged independently to provide high-quality service cost-effectively.