Does Reimbursement Affect Physician Decision Making?

  • Charles L. Bennett
  • Tammy J. Stinson
Part of the Cancer Treatment and Research book series (CTAR, volume 140)

Abstract

Cancer care is expensive, with large expenditures being associated with new technologies and Pharmaceuticals, supportive care modalities, and terminal care.1 Almost one third of an individual’s lifetime medical costs are incurred during the last several months of life. The high costs of cancer care raise important issues related to access to new cancer technologies. In particular, are all cancer patients equally likely to receive the expensive new medical developments? What is the relationship between patient’s socioeconomic status and type of health insurance and the use of cancer therapies? Do financial arrangements between physicians and insurers affect the type and intensity of cancer care? Do these factors have an effect on the type, quality, and results of care in the clinical oncology setting?

Keywords

Veteran Affair Cancer Care Peripheral Blood Stem Cell Peripheral Blood Stem Cell Transplantation Manage Care Organization 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Smith TJ. Role of granulocyte and granulocyte macrophage colony stimulating factors in clinical practice: Balancing clinical and economic concerns. American Society of Clinical Oncology Educational Book. 35th Annual Meeting. 1999: 275-299.Google Scholar
  2. 2.
    McIntosh H. Managed care brings major changes to cancer care. J Natl Cancer Inst 1995; 87:784–86.PubMedCrossRefGoogle Scholar
  3. 3.
    Hellinger FJ. The impact of financial incentives on physician behavior in managed care plans: A review of the evidence. Med Care Res Review 1996; 53(3):294–314.CrossRefGoogle Scholar
  4. 4.
    Bailes JS. Health care economics of cancer in the elderly. Cancer 1997; 80:1348–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Ogrod ES. Compensation and quality: A physician’s view. Health Affairs 1997; 16(3):82–86.PubMedCrossRefGoogle Scholar
  6. 6.
    Simon CJ and Emmons DW. Physician earnings at risk: An examination of capitated contracts. Health Affairs 1997; 16(3):120–26.PubMedCrossRefGoogle Scholar
  7. 7.
    Health News Daily. 1995. Half of US physicians are associated with risk insurance plans, Nov 13, p. 4.Google Scholar
  8. 8.
    Miller R, Luft HS. Managed care plan performance since 1980. J Am Med Assoc 1994; 271:1512–19.CrossRefGoogle Scholar
  9. 9.
    Manning WF, Leibowitz A, Goldberg FA, Rogers WH, Rogers JP. A controlled trial of the effects of a prepaid group practice on use of services. N Eng J Med 1984; 310:1505–10.CrossRefGoogle Scholar
  10. 10.
    Clancy CM, Hillner BE. Physicians as gatekeepers: The impact of financial incentives. Arch Int Med 1989; 149:917–20.CrossRefGoogle Scholar
  11. 11.
    Greenfield S, Nelson EC, Zubkoff M, et al. Variations in resource utilization among medical specialties and systems of care. J Am Med Assoc 1992; 267:1624–30.CrossRefGoogle Scholar
  12. 12.
    Rappaport J, Gehlback S, Lemeshow S, Teres D. Resource utilization among intensive care patients: Managed care versus traditional insurance. Arch Int Med 1992; 152:2207–12.CrossRefGoogle Scholar
  13. 13.
    American Society of Clinical Oncology. American Society of Clinical Oncology recommendations for the use of hematopoietic colony stimulating factors: Evidence based clinical practice guidelines. J Clin Onc 1994; 12: 2471–2508.Google Scholar
  14. 14.
    Update of recommendations for the use of hematopoietic colony stimulating factors: Evidence-based clinical practice guidelines. J Clin On 1996; 14: 1957–1960.Google Scholar
  15. 15.
    Bennett CL, Smith TJ, Weeks JC et al. Use of hematopoietic colony stimulating factors: The American Society of Clinical Oncology Survey. J Clin Onc 1997; 14: 2511–2520.Google Scholar
  16. 16.
    Bennett CL, Somerfield M, Feinglass J, Smith TJ. Decrease in misuse/overuse of hematopoietic colony stimulating factors for solid tumors and lymphomas: Results from ASCO Surveys Related to the 1994 and 1996 ASCO CSF Guidelines. Proceedings of ASCO 1998; 17: 421a.Google Scholar
  17. 17.
    Park RE, Brook RH, Kosecoff J et al. Explaining variations in hospital death rates. Randomness, severity of illness, quality of care. JAMA 1990; 264: 484–490.PubMedCrossRefGoogle Scholar
  18. 18.
    Bataladan P, Nelson E, Roberts J. Linking outcomes measurement to continual improvement: the serial “V” way of thinking about improving clinical care. Jt Comm J Qual Improv 1994; 20: 167–80.Google Scholar
  19. 19.
    Ullman M, Metzger CK, Kuzel T, Bennett CL. Performance measurement in prostate cancer: Beyond report cards. Urology 1996; 47: 356–65.PubMedCrossRefGoogle Scholar
  20. 20.
    Bennett CL, Tosteson TD, Schmitt B, Weinberg PD, Ernstoff MS, Ross SD. Maximum androgen blockade with medical or surgical castration in advanced cancer: A meta-anlysis of nine published randomized controlled trials and 4128 patients using flutamide. Prostate Cancer and Prostatic Diseases 1999; 2: 4–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Eisenberger MA, Blumenstein BA, Crawford ED et al. Bilateral orchiectomy with or without flutamide for metastatic prostate cancer. NEJM 1998; 339: 1036–42.PubMedCrossRefGoogle Scholar
  22. 22.
    Waters TM, Bennett CL, Pajeau TS, Sobocinski KA, Klein JP, Rowlings PA, Horowitz M. The Costs and Cost-Effectiveness of Bone Marrow and Peripheral Blood Stem Cell Transplantation: What Do We Know? Bone Marrow Transplant 1998; 21:641–50.PubMedCrossRefGoogle Scholar
  23. 23.
    Bennett CL, Armitage JL, Armitage GO, et al. Costs of care and outcomes for high-dose therapy and autologous transplantation for lymphoid malignancies: Results from the University of Nebraska 1987-1991. J Clin Oncol 1995; 13:969–973.PubMedGoogle Scholar
  24. 24.
    Freeman MB, Vose JM, Bennett CL et al. Costs of Care for High-Dose Therapy and Autologous Transplantation for Non-Hodgkin’s Lymphoma: Results From the University of Nebraska Medical Center 1989 Through 1995; Bone Marrow Transplantation 1999; in press.Google Scholar
  25. 25.
    Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 1979; 301:1364–1369.PubMedCrossRefGoogle Scholar
  26. 26.
    Welch HG. Valuing clinical strategies early in their development. Annals of Int Medl 16: 263–4; 1992.Google Scholar
  27. 27.
    Pavletic ZS, Bishop MR, Tarantolo SR, et al. Hematopoietic recovery after allogeneic blood stem cell transplantation compared to bone marrow transplantation in patients with hematologic malignancies. J Clin Oncol 1997; 15:1608–13.PubMedGoogle Scholar
  28. 28.
    Bennett CL, Waters TM, Stinson TJ et al. Valuing Clinical Strategies Early in Development: A Cost Analysis of Allogeneic Peripheral Blood Stem Cell Transplantation. Bone Marrow Transplantation 1999; in press.Google Scholar
  29. 29.
    Blaise D, Kuentz M, Fortanier C, et al. Randomized trial of lenograstim-primved blood cell versus bone marrow allogeneic transplantation: Comparison of haematological recovery and socioeconomic evaluation. Proceedings ofthe American Society of Hematology 1998; 557a.Google Scholar
  30. 30.
    Bennett CL, Stinson TJ, Yang T, Lurain JR. The Effect of Reimbursement Policies on the Management of Medicare Patients with Refractory Ovarian Cancer. Sem Oncol 1999; 26(1) Suppl A:34–39.Google Scholar
  31. 31.
    Ignoffo RJ. Medicare Reimbursement for Oral Antiemetics in Management of Chemotherapy-Induced Emesis. Am J Health-Syst Pharm 1997; 54:830–31.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Charles L. Bennett
  • Tammy J. Stinson

There are no affiliations available

Personalised recommendations