Oncology and Health Care Policy
Summary of Key Points
• Policies promulgated by government at the federal, state, and local levels have profound effects on virtually every aspect of the day-to-day practice of oncology. In the face of extreme financial pressures, policy makers will continue to make decisions that have tremendous impact on the cancer community.
• Federal policies play a critical role in cancer research. Although the national resources devoted to cancer research remain substantial (exceeding $5 billion in 2012), the nation is losing opportunities and efficiencies because of suboptimal funding. The combination of relatively flat funding for the National Cancer Institute since 2003 and biomedical inflation has eroded the effective level of federal support for cancer research by more than 20% during the past decade. The promise for new highly effective cancer therapies has never been brighter, and as a result, the need to amplify the cancer community’s commitment to ensure that adequate research funding exists has never been greater.
• There are many examples within the federal government of initiatives to create safeguards for patients with cancer through laws, regulations, and agency determinations. For example, genetic testing holds great promise to help prevent significant morbidity and mortality for individuals carrying genetic risk factors for certain types of cancer. Although care must be taken to avoid unnecessary regulation, too few protections are currently provided in this area. Oncologists are uniquely positioned to help agency officials establish more robust safeguards that promote and protect the interests of patients with cancer.
• Drug shortages have also emerged to challenge the oncology community and policy makers. During the past few years, there has been a worsening trend in which critical and often curative anticancer drugs are suddenly becoming unavailable to patients in the United States. In 2012, the U.S. Food and Drug Administration increased its efforts to tackle this issue, and Congress took initial steps to help address drug shortages. The oncology community should continue to work with Congress and federal agencies to address the complex issue of drug shortages.
• Policies adopted by the Medicare program regarding prevention, diagnosis, and treatment of cancer have greatly influenced both the practice of oncology and the services available to both Medicare and non-Medicare patients throughout the United States. Both public and private insurers often rely on coverage policies, reimbursement levels, and coding used by Medicare as a starting point for establishing their own policies. In the face of extreme economic pressure, oncologists and other cancer care professionals must remain engaged in helping to inform policy makers and to shape these changes. This effort includes working to ensure that policies designed to reduce health care expenditures do not undermine the quality of care received by persons with cancer and that reimbursement for cancer care is fair and adequate to permit the ongoing delivery of high-quality, high-value cancer care.
• Oncologists and other cancer care specialists have unique insights involving the care of patients with cancer, and it will continue to be increasingly important to communicate these insights effectively. Policy can have a profound impact on practice, making engagement in the process not only important but a professional responsibility.
1. How are the changes and oscillations in federal and state funding for cancer research during the past decade affecting the cancer research community?
A The prospect of flat or reduced funding for cancer research is impeding the development of clinical trials research studies.
B Insufficient and inconsistent funding destabilizes the working dynamic of research teams and deters new talent from entering the field.
C Oscillations in funding may delay the translation of new scientific discoveries to patient care.
2. What safeguards are included within the Genetic Information and Nondiscrimination Act of 2008?
A Bars discrimination in the areas of disability insurance and life insurance
B Supports insurance coverage for direct-to-consumer genetic testing
C Prohibits employers from basing employment and promotion decisions on genetic testing information
D Allows insurers to exclude individuals from the insurance market based on information revealed by genetic testing and expands the role of genetic counselors in hospital settings
3. Approximately what percentage of the cancer patient population in the United States receives health care insurance through the Medicare program?
4. Where do opportunities exist for oncologists and other cancer care professionals to influence the policies adopted by federal and state officials?
A Through litigation involving the judicial branch of government (including but not limited to the Supreme Court)
B Through communications and advocacy with officials in the executive branch of government, including officials at the agencies within the U.S. Department of Health and Human Services and state counterparts to help interpret the gaps, conflicts, and ambiguities existing in the relevant laws
C Through advocacy with involving the laws promulgated by Congress and state legislatures
1. Answer: D. Inconsistencies and insufficiencies in federal and state funding for cancer research have broad and diverse effects on the cancer community. Adverse consequences include a reduction in multiyear research studies, instability among research teams, recruitment challenges, and impediments to the application of new research to patient care. Although the national resources devoted to cancer research remain substantial, the nation is losing opportunities and efficiencies because of suboptimal funding.
2. Answer: C. The Genetic Information and Nondiscrimination Act of 2008 serves as an example of government regulation developed to promote patient safeguards. Patients may undergo genetic testing for the purposes of screening, diagnosis, or development of a treatment plan. The Genetic Information and Nondiscrimination Act of 2008 preserves the privacy of these patients by barring potential discrimination by employers and insurance companies based on the findings of genetic tests. Although care must be taken to avoid unnecessary regulation, there are currently too few protections in this area.
3. Answer: C. Medicare is a federal health insurance program that provides health care coverage for Americans older than 65 years and persons living with a disability. Because cancer is more prevalent in aging populations, approximately 60% of all patients with cancer receive insurance coverage through Medicare. The percentage of patients with cancer who receive health insurance from Medicare is predicted to grow significantly during the next two decades, which places even greater importance on the policies adopted by Medicare that affect patients with cancer and their families, oncologists, and other cancer care professionals.
4. Answer: D. Cancer care professionals have a critically important role to play in informing policy development with all three branches of government. Although litigation and legislation often capture the most headlines, agency officials within the executive branch of government possess significant discretion to interpret the gaps, conflicts, and ambiguities in laws enacted by the U.S. Congress and state legislatures.
