USING THE TAIL TO WAG THE DOG - A CONSUMERS PERSPECTIVE ON MANAGEMENTOF THE COST OF CANCER

This article describes the health insurance policy used by one, small, fully insured company. The most important benefits for reducing the h uman and financial cost of cancer are benefits that improve the decisi on processes of the healthy person, and a benefit that promotes involv ement of a primary care physician at the time of death. These benefits in our health insurance plan are designed to: 1) assure easy access t o a primary care physician; 2) provide incentives to teach the benefic iary to use the knowledge of the primary care physician as he/she make s decisions regarding care; 3) provide claims monitoring to identify s mall problems before they become serious; and 4) eliminate factors suc h as capitation and physician profiling, which provide strong financia l incentives for the primary care physician to disengage from the care of seriously ill patients. Once serious illness is identified, it is important to pay generously for the person's struggle to regain health . The strategy described in this article does not rely on networks or negotiations with providers, and therefore can operate uniformly throu ghout the U.S. All large companies using this strategy to date have ex perienced a permanent drop in health care costs, largely due to a redu ction in the incidence of expensive cases. (C) 1998 American Cancer So ciety.