ARE HEALTH-CARE REIMBURSEMENT POLICIES A BARRIER TO ACUTE AND CANCER PAIN MANAGEMENT

US health-care policy and recent literature are reviewed to examine wh ether there are reimbursement barriers to acute and cancer pain manage ment. The available evidence suggests that lack of coverage and uneven reimbursement policies for health care including prescription drugs, medical equipment, and professional services inhibit access to acute a nd cancer pain management for millions of citizens, in particular the poor, elderly, and minorities. Medicare, Medicaid, and HMO issues are reviewed. Available evidence suggests that the use of ''caps'' on pres cription drugs limits access to pain medications. Access to the opioid analgesics that are essential to pain management is limited by some s tate-controlled substances regulations and by some mail-order pharmacy policies. Controlled substances laws appear to create financial disin centives for pharmacies and hospices. Programs to help indigent patien ts obtain opioid analgesic medications are reviewed. Suggestions are o ffered for hospices to reduce costly waste of analgesic medications th at remain after patients die. Reimbursement for acute and cancer pain management should be reviewed and included in current efforts to refor m national