Commentary: The Cancer Care Delivery System in the 00s
Authors: William T McGivney
Journal: Journal of the National Comprehensive Cancer Network (2004)

The Cancer Care Delivery System in the 00sIn this new JNCCN feature, experts will address issues and programs that will influence the delivery system for cancer care over the next decade.Individual submissions for this new section of JNCCN are most welcome.The return of substantial rates of rise in national health care expenditures, health insurance premiums, and employer contributions is beginning to make the current environment feel a lot like the health care system in the late 1980s and early 1990s.In those days, rising health care costs brought tremendous tension and pressure to bear on both employers and patients in their roles as purchasers of care.These pressures were translocated to health insurers, who were charged to reduce the pressures and, thus, sought to morph into companies that could manage health care.Hence, a managed care industry emerged.Managed care companies did have some modest and transient success in moderating the rate of rise of health care expenditures in the mid to late 1990s.The one successful mechanism used to accomplish this was a focus on aggressively negotiating down the reimbursement for services provided by facilities and by professionals.Managed care companies used the specter of provider exclusion of from "narrow networks" to extract pricing concessions.These pricing concessions from providers were achieved in the early years of the 1990s, when managed care companies rode the crest of power.However, that power began to recede in 1995.The Clinton Health Care Reform debate of 1994 provided one conclusive result, and that was the affirmation of the need for "choice" for patients and their families in deciding the most appropriate and effective provider and provider setting for the delivery of the care they needed.Employers, as direct influencers of the "product lines" of managed care companies, embraced the concept of "choice."Thus, the leverage carried by the threat of narrow networks began to diminish for managed care companies in the negotiation and quest for ever-lower reimbursement for provider services.What did not diminish was the steady and increasing flow of innovative technologies (drugs, devices, procedures, and techniques) into the health care system.Many of these technologies offer advantages in safety and effectiveness.Many also come with a higher price tag and, in some instances, are used in concert with existing standard clinical interventions.Thus, although the negotiating power of the managed care companies provided a brief respite from accelerating health care costs, the reality of demand for consumer choice, regrouping of the provider side, and infusion of new technology resulted in a predictable, strong resurgence in health care pricing pressures.Cancer care was at the forefront of coverage and reimbursement issues in the 1990s and will find itself positioned similarly in this new millennium.This is because the oncology research enterprise has pipelines replete with promising new drugs and biologic agents designed for disease states that are serious and life-threatening.The inadequacies of existing interventions for some cancers are being addressed incrementally and, in a few cancers, substantially, with the introduction of new diagnostics and treatments.The demand for such innovative technologies is strong from patients, providers, and society as a whole.Additionally, the lower toxicity profiles of new agents will convert the