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 Center.
"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."