Today, the US health-care system is being driven by a desire to contain escalating health-care expenditures. Oncology has not been spared, and the cancer burden on this country is great in terms of monetary costs as well as human morbidity and mortality.
As managed care health plans turn to clinical financial pathways and capitation to save money in oncology services, they will ultimately have to demonstrate the quality of the services they provide if they expect to remain viable in a competitive marketplace.
Cost Containment Threats
While managed care plans and other efforts at cost containment do not necessarily result in poor quality of care, policies directed only at reducing costs are likely to have such an effect. The quality of oncology care is particularly vulnerable to threats from cost containment due to a number of unique aspects of cancer care (see Table 1).
Many clinicians and patients have already witnessed the adverse effects of haphazard cost cutting, including closed drug formularies, restrictions on off-label drug uses, denial of coverage for patient care costs incurred during clinical trials, and overly restrictive policies governing patient access to oncology specialists, psy-chosocial services, and specialized facilities like NCI-designated cancer centers.
It is not hard to imagine further restrictions and a greater shift of the responsibility for patient care to patients and their family members if policies to guard and improve the quality of oncol-ogy care are not implemented.
The Cancer Process
While cancer consists of many different diseases, each requiring specialized care, a general cancer process can be defined. We divide this process into the following broad phases of care: acute care, subacute care, and long-term care.
This overall process contributes to the unique aspects of cancer care that make it so costly. Although this process will unfortunately not be completed by all patients, it emphasizes the need for coordinated medical care, both physical and mental, throughout each period.
- Acute care includes detection, diagnosis, and treatment. The detection and diagnosis phase sets the foundation for the relationship between the patient and oncologist as well as the subsequent treatment regimen.