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Disorders of the Male Reproductive System

Disorders of the Male Reproductive System

Men's health issues are increasingly recognized as significant, with several conditions posing common threats. Among these, testicular cancer is especially prevalent in younger men, particularly those aged 20 to 35 years. The disease often manifests as a painless mass in the testicles, sometimes accompanied by a sensation of heaviness or a dull ache.
Prostate disorders are another major concern. These conditions can impair urinary flow due to the prostate's location around the urethra....

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A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance

A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance

Published on: November 7, 2025

Evidence-based HMO care for prostate specific antigen testing.

Daniel J Merenstein¹, Frank J D'Amico^2,3, Shlomo Vinker^4,5

¹Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA.

The International Journal of Health Planning and Management

|September 21, 2016

Summary

This summary is machine-generated.

Pre-paid healthcare systems, like Israel

Keywords:

HMO PSA fee-for-service pre-paid

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Area of Science:

Urology
Health Services Research
Health Economics

Background:

Healthcare systems globally are shifting from fee-for-service to pre-paid models.
The impact of pre-paid systems on evidence-based care, particularly for prostate cancer screening, remains unclear.
Prostate-specific antigen (PSA) testing is a key area for evaluating care patterns.

Purpose of the Study:

To evaluate adherence to evidence-based guidelines for PSA testing in a large, pre-paid Health Maintenance Organization (HMO) in Israel.
To compare PSA testing rates in Israel with those reported in the U.S. fee-for-service system.
To assess the implications of pre-paid models on the utilization of diagnostic tests.

Main Methods:

Retrospective cohort study of ambulatory visits from 2002-2011.
Inclusion criteria: patients aged over 75 receiving care from Clalit Health Services.
Primary outcome: percentage of patients undergoing at least one PSA test after age 75; comparison with U.S. data.

Main Results:

Annually, 22% of eligible Israeli men underwent PSA testing, regardless of malignancy or benign prostatic hyperplasia diagnosis.
Over the 10-year study period, 30% of men had at least one PSA test.
These testing rates are significantly lower than those previously reported in the U.S.

Conclusions:

Physicians in a pre-paid system without direct financial incentives for testing order PSA tests less frequently than in the U.S. fee-for-service system.
The findings suggest pre-paid models may influence diagnostic test ordering behavior.
Continued examination of quality measures is crucial as the U.S. transitions healthcare payment models.