Oncologists' and family physicians' views on value for money of cancer and congestive heart failure care.
BACKGROUND
Previous studies suggest that cancer-related interventions are valued by policy makers more favorably than interventions for other medical conditions, but the views of practicing physicians have not yet been assessed in Israel. Attitudes and judgments of practicing physicians may assist decision-makers in their deliberations on coverage of new technologies. We conducted a national survey in Israel among oncologists and family physicians to explore their views on access to care, coverage decisions and treatment recommendations for cancer and congestive heart failure (CHF) patients.


METHODS
We administered a web-based survey to 300 family physicians and 156 oncologists. The questionnaire included 24 statements and physicians were asked to indicate their level of agreement with each statement on a 5-point Likert scale, ranging from "strongly agree" to "strongly disagree". Where relevant, physicians were asked to express their views on interventions for cancer and CHF respectively.


RESULTS
Response rates were 39% for family physicians and 36% for oncologists. Participants expressed similar views on cancer and CHF care and no significant differences were found between the two medical specialties. More than 85% of physicians believe that inclusion of a treatment in the National List of Health Services (NLHS) strongly affects their patients' access to care. Approximately 80% suggest that more use of comparative-effectiveness and cost-effectiveness analysis is needed in coverage decisions. The vast majority of respondents (75%) suggest that assessment of value-for-money should be made by an independent (academic) institution or the national committee responsible for recommending coverage decisions, Seventy percent believe that treatments not included in the NLHS should be included in supplementary health insurance programs and only a small minority of respondents (<30%) believe that cancer-related interventions should receive higher priority than non-cancer interventions in coverage decisions.


CONCLUSIONS
Our findings suggest that both oncologists and family physicians value cancer and CHF interventions equally. We could not find evidence for a "cancer premium" as implied from previous surveys and analysis of coverage decisions in various countries.
Department of Health Systems Management, Faculty of Health Sciences & Guilford Glazer School of Business and Management, Ben-Gurion University of the Negev, P.O.Box 653, Beer-Sheva 84105, Israel ; Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA.
Dan
D
Greenberg
Chief Physician's Office, Clalit Health Services Headquarters, Tel-Aviv, Israel.
Ariel
A
Hammerman
Chief Physician's Office, Clalit Health Services Headquarters, Tel-Aviv, Israel.
Shlomo
S
Vinker
Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel.
Adi
A
Shani
Department of Health Systems Management, Faculty of Health Sciences & Guilford Glazer School of Business and Management, Ben-Gurion University of the Negev, P.O.Box 653, Beer-Sheva 84105, Israel.
Yuval
Y
Yermiahu
Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA.
Peter J
PJ
Neumann