SUPPORTS FOR AND CONSTRAINTS ON SERVICE AVAILABILITY

In addition to the policy support for interventions aimed at delivering psychosocial services described above, policies need to support the availability and accessibility of the various services patients require. Multiple health and human services sectors of the U.S. economy are involved in either directly delivering or providing for these services. They include government purchasing and insuring programs, such as Medicare and Medicaid; private-sector purchasers and insurers; the large voluntary sector, including voluntary services provided by health care organizations, such as hospitals, that otherwise require reimbursement for their services; programs offered by federal and state government agencies, such as the National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC), and state health departments; and the informal support system of family, friends, and other social networks that provide supportive services. Additionally, many services are available for purchase in the marketplace.

Policies Supporting Service Availability

Table 6-3 lists some of the psychosocial services available from the various sectors cited above, which together form a comprehensive array of such services. Several features of this array are particularly noteworthy. First is the complexity of the providers and the services they offer, which underscores the need for policy support for care coordination and care navigator services, as discussed in Chapter 4 and above. The large role of the voluntary sector also is clear, highlighting the invaluable role played by this sector in cancer care (see also Tables 3-2 and 3-3 in Chapter 3). This partial listing of available services also counters the potential concern that “there is no point in identifying individuals who need psychosocial services because there is nothing to offer them.” The voluntary sector has striven to ensure the availability of substantial psychosocial services for patients with cancer and their families, and the committee concurs with an earlier IOM report that found a “wealth of cancer-related community support services” (IOM and NRC, 2006:229).

The important role of family and other informal supports in providing critically needed services such as transportation and assistance with activities of daily living also is visible, especially in light of the limited availability of these services from other sources. Policies need to support these informal supports for several reasons. First, informal caregivers often know the patient best, and can tailor their support to the patient’s unique needs and preferences. Their service to the patient often comes from their personal love or affection, which a business or regulatory model of care



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