BETHESDA, Md-Robert W. Day, MD, told fellow members of the National
Cancer Advisory Board (NCAB) that a brief survey he sent to teaching
hospitals across the country showed that reimbursement per case
has dropped, and the likely culprit is managed care.
"The profit margin that was used to support training and
clinical research is now gone," said Dr. Day, president and
director, Fred Hutchinson Cancer Research Center, Seattle, "and
the single biggest payer in the country, Medicare, has an exclusion
against anything experimental, including clinical trials. That
needs to change."
Although the survey showed no recent change in the number of patients
going into clinical trials, a crisis may be impending.
Dr. Frederick F. Becker, vice president for research and scientific
director, The University of Texas M.D. Anderson Cancer Center,
said that the city of Houston has had 25% penetration by managed
care and that the income of his hospital has already fallen by
almost that amount.
This reduction in income will negatively affect the dollars available
for clinical research, Dr. Becker said, adding that "it is
only a matter of time before clinical research will be in crisis."
In California, the money paid per patient in clinical trials has
dropped by 34%, said Dr. Charles Wilson, director, University
of California, San Francisco Neurosurgery Brain Tumor Research
"We have done a poor job of selling clinical trials to insurers
and managed care plans," Dr. Wilson said. "The best
standard treatment for a cancer patient may be a trial,
and that needs to be made clear to insurance companies."