The week after President Obama signed the US Stimulus Bill, which provides the National Institutes of Health with $10 billion and gives hope to American cancer funding, The Lancet Oncology publishes a series of reports exposing the reality of cancer services in the US as the recession bites harder. The US government mismanaging health 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, are all examined in these hard-hitting reports.
In a Leading Edge, The Lancet Oncology claims that: "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."
The Lancet Oncology points out that the new policy of allowing Medicare to cover the cost of treatments not approved by the Food and Drug Administration (FDA), will give oncologists the green light to prescribe medicines even if evidence of their efficacy and safety is inconclusive. This, it says, will put patients' safety at risk, inflate healthcare costs, undermine the incentive for future research, and widen health inequalities.
According to the Leading Edge, this recent policy change is in complete contradiction to the joint announcement in 2008 by the Centers for Medicare and Medicaid Services and the FDA—to work together to improve patient safety—and highlights a failing of the Department of Health and Human Services: "That it has allowed two of its own agencies to work independently without common objectives."
So what is the solution to this lack of joined-up thinking in cancer services and drug provision? The Lancet Oncology calls for a focus on patient-centred medicine rather than government or insurer-imposed medicine, this it argues, will improve care for cancer patients, increase accessibility to all, and may even reduce healthcare budgets.
In a related Keynote Comment, Joseph Simone from the University of Florida Cancer Center, USA, examines "the unjust and wasteful" reimbursement system for medical care in the US and discusses how the government is not always to blame for medical cost problems.
According to Simone, "the venture capitalists" of the cancer world, also known 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.
One solution, says Simone, would be to rebalance 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 feature examines the toll of the economic downturn on cancer care in the US. 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. This decision will hit middle-income employees used to employer-provided health insurance very hard. Even the proposal to cover former employees with government subsidised insurance schemes for up to a year has been reduced to 9 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", predicts an expert from the US, "at least 25 000 patients with cancer undergoing treatment in 2009 will lose coverage as a result of this recession."
Worryingly, things could get even worse. Nick Bosanquet from Imperial College in London, UK, claims that the US stimulus package is just a short-term boost: "Cancer research is about to get a happy hour but serious affordability problems may arise long-term as the 'once and for all' public spending boom ends in debt driven decline."
For Leading Edge, Keynote Comment and Feature see: http://press.thelancet.com/RecessionUS.pdf
Journal
The Lancet Oncology