title: Last chance therapies and managed care. Pluralism, fair procedures, and legitimacy.
abstract: How can health plans make fair determinations about when "experimental" (and costly) treatments such as high dose chemotherapy with autologous bone marrow transplantation should be covered despite lack of clear clinical consensus about their benefits? Different models for managing "last chance" therapies evolving in some health plans offer promising examples of how issues of fairness and legitimacy in decision-making can be addressed.
authors.affiliation: Tufts University, USA.
authors.forename: N
authors.initials: N
authors.lastname: Daniels
authors.forename: J E
authors.initials: JE
authors.lastname: Sabin
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000191:economics*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D018864:Cultural Diversity; D003657:Decision Making; D004992:Ethics, Medical; D005260:Female; D033161:Government Regulation; D006301:Health Services Needs and Demand; D006801:Humans; D019458:Insurance Coverage; D008329:Managed Care Programs; D026706:Paternalism; D026684:Personal Autonomy; D011785:Quality Assurance, Health Care; D040841:Resource Allocation; D018570:Risk Assessment; D012941:Social Responsibility; D036302:Therapeutic Human Experimentation; D035703:Therapies, Investigational; D014182:Transplantation, Autologous; D014481:United States
chemical_list: D000970:Antineoplastic Agents