HEALTH-CARE POLICIES AFFECTING THE TREATMENT OF PATIENTS WITH CANCER AND CANCER-RESEARCH

Background. Reimbursement policies under the current health care finan cing system are chaotic, even for older individuals who might expect s ome measure of uniformity under federal statues that govern coverage u nder Medicare, Policy changes at the federal level have increased the complexity and uncertainty of reimbursement for providers and patients . Methods. The Association of Community Cancer Centers, in conjunction with a number of state medical oncology societies, distributed survey s to medical oncologists in 20 states during 1993. Eight hundred, fift y-six medical oncologists in 282 practices responded with information on their practices and insurance problems. Results. Data illustrate th e broad diversity of coverage for cancer treatment and research and it s impact on treatment decisions and patient access. The broad spectrum of results from various states indicates significant differences in t he implementation of federal policies on key issues, such as access to chemotherapeutic agents for off-label indications and clinical trials . Conclusions. The data portray the significant influence of insurance company policies on clinical research and disease prevention and trea tment. Under the current system, prevention measures and prevention tr ials are discouraged, and a growing number of insurers are not paying for clinical research. New state and federal legislation offers some h ope that uniformity of access to providers, prevention, off-label drug s, and clinical trials may be on the horizon.