title: Health care policies affecting the treatment of patients with cancer and cancer research.
abstract: BACKGROUND
  Reimbursement policies under the current health care financing system are chaotic, even for older individuals who might expect some measure of uniformity under federal statues that govern coverage under Medicare. Policy changes at the federal level have increased the complexity and uncertainty of reimbursement for providers and patients.
  
  
  METHODS
  The Association of Community Cancer Centers, in conjunction with a number of state medical oncology societies, distributed surveys to medical oncologists in 20 states during 1993. Eight hundred, fifty-six medical oncologists in 282 practices responded with information on their practices and insurance problems.
  
  
  RESULTS
  Data illustrate the broad diversity of coverage for cancer treatment and research and its impact on treatment decisions and patient access. The broad spectrum of results from various states indicates significant differences in the implementation of federal policies on key issues, such as access to chemotherapeutic agents for off-label indications and clinical trials.
  
  
  CONCLUSIONS
  The data portray the significant influence of insurance company policies on clinical research and disease prevention and treatment. Under the current system, prevention measures and prevention trials are discouraged, and a growing number of insurers are not paying for clinical research. New state and federal legislation offers some hope that uniformity of access to providers, prevention, off-label drugs, and clinical trials may be on the horizon.
authors.affiliation: Association of Community Cancer Centers, Rockville, MD 20852.
authors.forename: L E
authors.initials: LE
authors.lastname: Mortenson
mesh_terms: D002986:Clinical Trials as Topic; D003365:Costs and Cost Analysis; D006291:Health Policy; D006801:Humans; D007345:Insurance Claim Review; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008329:Managed Care Programs / Q000191:economics; D008495:Medical Oncology / Q000191:economics / Q000458:organization & administration; D006278:Medicare / Q000191:economics; D009369:Neoplasms / Q000517:prevention & control / Q000628:therapy*; D011216:Practice Management, Medical / Q000191:economics; D012106:Research; D014481:United States