This column is the first in a series of articles in Oncology News
International that will focus on the impact of managed care on
oncology practice. The series will discuss aspects of managed
care that need to be considered by oncologists, either in communities
or in academic centers, to remain state-of-the-art into the 21st
Why is this type of column worthwhile? Oncology has been one of
the most exciting specialties in medicine over the past years
because of the impact of new technology. This has increased the
ability of physicians to cure and manage neoplastic disease.
Oncologists have had professionally satisfying opportunities to
apply different technological advances (eg, in genetics, pharmacology,
infectious disease, and psychology) to a diverse group of patients.
In addition, they have had the opportunity to conduct a wide range
of challenging clinical investigations in a setting in which patients
have been willing to undergo intensive therapies.
However, with the recognition that payers in American society
(employers, corporations, individuals, and the federal government)
are no longer willing or able to pay "whatever it takes"
to get the maximal care necessary to improve the health of every
individual, limitations have been placed on payments for health
care. Globally, these are called health-care reform.
Health-care reform involves a new paradigm, including review of
the decisions of oncologists by others--managers at insurance
companies and corporations (often nurses), as well as government
clerks and administrative personnel, and even our own peers.
Society has now formed a consensus that limitations must be placed
on medical resources. Individuals, however, still demand that
everything be done, leading to ethical dilemmas in certain situations.
How should today's oncologist prepare for this increasing degree
of limitation of resource utilization as we proceed into the 21st
century? What issues should an on-cologist be addressing today
so that he or she can, over the next few years, continue to bring
high quality health care to individuals while also managing resources
in a cost-effective manner?