Clinical Trial Reimbursement

  • Three states (Georgia, Maryland, and Rhode Island) have laws requiring insurance reimbursement for cancer treatment provided as part of a clinical trial, but not all studies are applicable.

Protections for the Indigent

  • The Maryland legislature has passed a law requiring screening and treatment for needy women without access to care.

SOURCE: NCI, 1998b.

Over the past few decades, managed care has grown to become the dominant organizing and financing mechanism for U.S. health care, changing dramatically the way in which health care services are delivered. Individuals with cancer are less likely to be covered by managed care plans because they are elderly and tend to have Medicare's traditional fee-for-service coverage. Nevertheless, many aspects of cancer care—for example, access to specialists, coverage for drugs and ancillary services, and use of practice guidelines—differ in managed care compared to fee-for-service care. In response to market forces, managed care organizations have consolidated, diversified, and become quite heterogeneous, making it difficult to generalize about their impact on cancer care. States, in some instances, have tried to counter the effects of managed care by mandating certain benefits or consumer protections. These mandates, however, do not apply to many Americans whose health plans are self-funded by an employer and therefore exempt from state regulation.

References

American Cancer Society. 1999. Cancer Facts and Figures1999. Atlanta, GA: American Cancer Society.

American Hospital Association, 1999. Hospital Statistics: 1999 Edition . Chicago: American Hospital Association.

American Medical Association. 1997. Physician Characteristics and Distribution in the U.S. 1996-1997 Edition. Chicago: American Medical Association.

American Medical Association. 1998. Physician Characteristics and Distribution in the U.S. 1997-1998 Edition. Chicago: American Medical Association.

American Society of Clinical Oncology. 1998. Cancer care during the last phase of life. Journal of Clinical Oncology 16(5):1986-1996.


Bailes JS. 1995. The economics of cancer care. Cancer 76(10 Suppl.):1886-1887.

Bell N. 1997. Approaches to cancer management vary widely. Faulkner & Gray's Medicine and Health Perspectives 51(27):3.

Bennett C, Buchner D, Ullman M. 1997. Approaches to prostate cancer by managed care organizations. Urology 50(1):79-86.



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