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Evidence-Based Oncology July 2016

Lessons to Learn From the NICE Cancer Care Model

Surabhi Dangi-Garimella, PhD
On the first day of the annual meeting of the American Society of Clinical Oncology, healthcare experts from the United States, Canada, and the United Kingdom, compared and contrasted the care models that are widely adopted in each nation.
On the first day of the annual meeting of the American Society of Clinical Oncology, held June 3-7, 2016, in Chicago, IL, healthcare experts from the United States, Canada, and the United Kingdom, compared and contrasted the care models that are widely adopted in each nation. Placing a significant emphasis on reviewing the value of cancer care, panelists discussed how the National Institute for Health and Care Excellence (NICE) in the United Kingdom, and the Canadian healthcare model, seek to optimize the cost and value of cancer care. Panelists also identified opportunities for constructive interventions that could help fill existing gaps in the US healthcare system.

United States
Susan Rogers, MD, FACP, Stroger Hospital of Cook County, Physicians for a National Health Program, introduced the US healthcare system during her talk, Perverse Incentives and Broken Markets: How Did We Get Here and How Do We Correct It?
Rogers posed the question, “Why do we need a single payer?” But, before trying to answer that question, she explained why health insurance is so important. Rogers said that insuring against health:
  • Protects financial assets
  • Improves access to care
  • Protects health
“The United States has 5 health delivery systems,” Rogers said, listing them as:
  1. Medicare
  2. Medicaid
  3. Private insurance offered to workers where they have to contribute to the premium
  4. Healthcare for Native Americans, vets, and the military, provided and delivered by the government (socialized medicine)
  5. Healthcare for the uninsured
“We are spending a lot of money on healthcare. The US public spending per capita for health is greater than the total spending in other nations,” Rogers said, with accompanying slides showing that US spends significantly greater than the highest amount spent by other developing countries. She emphasized that the increased spending does not guarantee improved outcomes, such as an improvement in the infant mortality rate or improved longevity.

So how can we improve access to better healthcare? Rogers pointed out that employment alone does not guarantee health benefits because a lot of employers prefer part-time employees, who then do not qualify for health benefits. With Medicaid expansion following the Affordable Care Act (ACA), there was hope that disparities in access to healthcare would be addressed. But it was not to be. “If half the physicians are not participating in Medicaid managed care plans, how can patients access care with those doctors?” Rogers asked. Despite the provisions within ACA, the Congressional Budget Office has estimated that 30 million will remain uninsured in 2016 and the number will hover around 29 million until 2019.1

The ACA has not really helped the US population, Rogers said, because a standard benefits package was not developed under the ACA—so many services are not covered by the health plan till the enrollee meets the target deductible amount. Copays and coinsurance were eliminated for enrollees, but only for preventive services and annual wellness visits. “ACA makes underinsurance the norm,” she said. With the average deductibles steadily rising, from $300 in 2006 to $1077 in 2015, medical bankruptcies are significantly higher, especially among cancer patients, Rogers pointed out.



 
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