I recently viewed a YouTube piece titled "Protecting Cancer Care: Improving Transparency and Patient Access" that was posted by the Alliance for Patient Access," a national network of physicians dedicated to ensuring patient access to approved therapies and appropriate clinical care. AfPA accomplishes this mission by recruiting, training and mobilizing policy-minded physicians to be effective advocates for patient access." While accessing this information, I became interested in reading the white paper mentioned as reference. And within this document, there was one thing that particularly caught my eye that I want to address, and that was the information included regarding the disparity in treatment for cancer care and the lack of transparency regarding this issue.
The single biggest thing that immediately shocked me was the difference that one may find in healthcare costs for the same procedure in the same geographic area with a variance of more than 100%. In the same studies it was shown that it has been estimated that by reducing price variations like this for insured individuals, some $36 billion could be saved annually. As if it weren't already difficult enough for breast cancer patients to have to learn about the cost of their care and what is and is not covered by their insurance and what their out-of-pocket expenses may be, it is a real blow if you find out that you are being charged so much more than others who are receiving the exact same treatment. But, this is not even the whole picture!
Imagine that your treatment is being governed by what is called "Clinical Pathways." Clinical pathways specify which treatment a patient should receive and in what order the treatments are to be delivered. These pathways are being developed with insurers working with physicians in an effort to reduce costs and even improve cancer care. But, some of these pathways do not rely so heavily on evidence but rather are based upon the cost of care. On top of that is something that is even more disturbing to me. Oncologists are also paid a bonus per patient, per month, for each patient that is kept on the "clinical pathway."
I see this as a major problem in that a breast cancer patient's treatment can be as unique as a person's fingerprints and to create one system to fit everyone with a financial incentive is to take away what may truly be what is the best treatment for the patient. This idea took me right back to the day when my first oncologist indicated that the best treatment for me, based upon someone my age with my stage of cancer was chemotherapy and then radiation. Since I chose to find a different oncologist, who tested the actual cancer that I had removed in order to make a decision on what the best treatment course would be for me, not only was chemotherapy not recommended but also radiation treatment was optional in my case.
I am sure that I am not the only one who may have been sent down a "clinical pathway" had I just blindly followed what I was originally directed to do. But unless we demand greater transparency across the entire healthcare system so that the costs of procedures and medications are readily available and understandable, patients will not be able to make informed healthcare choices. This is especially true for diseases like cancer where a course of treatment may make the difference between a successful patient outcome or even life or death.
Patients who have paid their insurance premiums and/or Medicare payroll taxes for decades deserve to receive help when paying for cancer treatments. Policymakers and citizens must work to protect patient access to cancer treatments by promoting transparencies and regulating unfair insurance practices that do not provide equal coverage for comparable services and treatments. In this way, each patient will be provided with a better ability to make choices in treatment for their individual cancer situation.
And a second benefit will be derived. By not paying medical professionals to provide unneeded services to patients so that they can receive monthly bonuses, insurance companies will actually be able to lower their premium rates because of the monies saved to pay not only the bonuses but also the costs for the treatments. This sounds like a winning situation for every patient as well as every person who pays insurance premiums.