The NY Times reports on a trial program to try to bring down Medicare costs. Expensive treatments would be allowed for 3 years, and if they don't improve health outcome, their reimbursement rate would be cut to the less expensive alternatives. The problem I see with this is that treatments may work for some people and not for others -- maybe even not for the majority. But I also understand that we have to do something to control costs. So what's the right answer?
Both the NY Times and the Wall Street Journal report on a different type of initiative for cancer patients. The Wall St. Journal says Unitedhealthcare will be paying doctors a set price for treating a cancer patient no matter what drug they use. The idea is to take away any incentive to use more expensive drugs. What if a patient needs the more expensive drug? The doctor has to eat the cost? The NY Times article is broader and talks about several initiatives by different large insurers. Apparently, an Aetna program found that when doctors stick to standard treatments, costs fall and patient outcomes do not change. If the more expensive drugs don't have any positive effects, is it okay to make it harder to get them? Again, what if you're the one patient who needs the more expensive alternative? Apparently, the doctors will check each other's charts and make sure nobody is skimping on care.
Innovative approaches to patient care are sorely needed. In every case, though, they must be balanced against patient care. The hard choices will be for the patients on the fringe, who don't respond to the less expensive treatments and need the more expensive drugs to function -- indeed, sometimes to live. This is all very interesting and rational until you're the patient who can't get what you think you need. I don't have all the answers and I applaud those who are trying to come up with solutions. But these programs need to be monitored carefully to ensure that we are not denying patients the care they need. Jennifer