Payment reform's impact on socioeconomic disparities may not matter if the growth in healthcare expenditures in the United States means the government or payers can’t afford to pay for the medicines, said Andrew L. Pecora, MD, FACP, CPE, chief innovation officer professor and vice president of cancer services at the John Theurer Cancer Center.
Andrew L. Pecora, MD, FACP, CPE: It’s a complex question because socioeconomic impact, it’s not a unidirectional issue. So, on the one hand, people who are less fortunate socioeconomically, they have a number of challenges that go beyond the disease they have. Can they get to the doctor’s office because they don’t own a car? Can they miss work because they need to work to pay to live? Do they live in an environment that’s a healthy environment where they’re getting good fresh food? All of those things impact. That’s one issue.
Compliance to prescribed therapy is another. It’s very hard sometimes, particularly with serious illness, when you have a family to deal with, you have a job, you don’t feel good, and then you have medications that are very expensive, and you have to take them in a frequency that is a challenge to you. That if you’re in a lower socioeconomic group, that may be a problem.
So, when you think about payment reform, what is it trying to do? I think it’s on a different level than that issue. I think the issue is is that it’s a zero sum game. Despite the fact we’re the most prosperous nation on the planet Earth, we can’t afford to sustain the growth in healthcare expenditures. Everyone agrees with that, and the problem we have right now is that the pace of acceleration is increasing in regard to discovery, and discovery, every new discovery drives more expense. So you have more discovery, more expense, people living longer because of these wonderful new drugs but costing more, and we can’t afford that.
The point we’re coming to, which would be a crisis point, is at some point we’d have to ration care. And then, regardless of your socioeconomic status—you could be rich, you could be poor—if the government or payers can’t afford to pay for the medicines, well, then you’re not going to get them. And so I think it’s a 2-tiered issue on the personal level, on the human level. There are challenges that payment reform might in part disproportionately on someone who doesn’t have the means of someone who does, but on the bigger level, if that patient, regardless of their means needs a certain medication and we can’t afford to give it to them, that’s a whole other problem.