While President Barack Obama's stimulus bill earmarks $10 billion for the National Institutes of Health (NIH), and gives hope to future cancer funding, the Lancet Oncology published a series of reports exposing a bleaker reality for cancer services in the United States as the recession worsens.
The reports concluded that the U.S. government is "mismanaging healthcare budgets for cancer patients, while continuing to encourage a profit-focused health service, to the detriment of many thousands of cancer patients who have insufficient funding to finish their ongoing cancer treatments."
"Fragmented decision-making by government departments, agencies and insurers, often working in isolation and without a common framework of objectives, is causing an increasingly unfair distribution of cancer services," according to the Leading Edge report.
The Lancet Oncology noted that the new policy of allowing Medicare to cover the cost of treatments not approved by the FDA will give oncologists the green light to prescribe medicines even if evidence of their efficacy and safety is inconclusive. This decision "will put patients' safety at risk, inflate healthcare costs, undermine the incentive for future research and widen health inequalities."
According to the report, the policy change completely contradicts the joint announcement in 2008 by the Centers for Medicare & Medicaid Services (CMS) and the FDA to work together to improve patient safety, and highlighted that the Department of Health and Human Services (HHS) "has allowed two of its own agencies to work independently without common objectives."
As a solution, the Lancet Oncology called for a focus on patient-centered medicine rather than government or insurer-imposed medicine, this it argues, will improve care for cancer patients, increase accessibility and may even reduce healthcare budgets.
In an accompanying keynote commentary, Joseph Simone, MD, from the University of Florida Shands Cancer Center in Gainesville, examined "the unjust and wasteful" reimbursement system for medical care in the United States and discussed how the government is not always to blame for medical cost problems.
"The venture capitalists" of the cancer world, which he characterized as "senior members in large multi-specialty medical oncology practices, are making millions of dollars a year from selling technical services like chemotherapy, surgery, and diagnostic imaging to patients at a profit," according to Simone.
Simone wrote that one solution would be to re-balance payments for the intellectual and humane aspects of care--such as examining a patient, or explaining a prognosis--which are not considered to be worth as much as procedures like surgery that use technology, and are very poorly reimbursed.
A related Lancet Oncology feature examined the toll of the economic downturn on U.S. cancer care. The recession has meant a loss of job-related health insurance for the 3.6 million recently unemployed. Despite an $87 billion package for Medicaid, the unemployed have not been granted access to this system, which "will hit middle-income employees used to employer-provided health insurance very hard. Even the proposal to cover former employees with government subsidized insurance schemes for up to a year has been reduced to nine months."
Of increasing concern is the cost of cancer drugs, which have risen at many times the rate of inflation of other healthcare costs. "We will probably see an increasing number of Americans priced out of the market for ongoing cancer care...at least 25,000 patients with cancer undergoing treatment in 2009 will lose coverage as a result of this recession," according to the feature.