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1989
Purchasing Oncology Services:
Current Methods and Models in the Marketplace
Supplement to Cancer
Introduction
Myles P. Cunningham,
M.D.
Department of Surgery, St. Francis Hospital,
Chicago, Illinois; Immediate Past-President,
American Cancer Society, Atlanta, Georgia.
Presented at the American Cancer Society National Conference on Purchasing Oncology Services: Current Methods and Models in the Marketplace, Chicago, Illinois, September 11–12,
1997.
Address for reprints: Myles P. Cunningham,
M.D., Department of Surgery, St. Francis Hospital, 800 Austin Street, Suite 501, Chicago, IL
60202.
Received February 13, 1998; accepted February
17, 1998.
T
he nation’s health care system has evolved rapidly in the last 20
years from a traditional, predictable, cost-plus or fee-for-service
arrangement to a market-driven, price sensitive, alternative system
largely driven by cost control. Until quite recently, managed care
has held down costs. It also has been embraced by employer and
purchasing groups, deplored and even condemned by large segments
of the provider community, and accepted with a mixture of relief,
reluctance, resignation, and skepticism by a public uncertain of its
ultimate value.
The American Cancer Society (ACS) has long opted to be a patient
and consumer advocate. It has been concerned by the high costs and
complexity of cancer care and especially by the lack of access to
necessary health assurance strategies for large numbers of poor and
underserved Americans. It has been equally concerned by a threatened or perceived loss of quality or availability of prevention, screening, diagnostic, and treatment services for patients enrolled in managed care plans. At the same time, the ACS recognizes that managed
care offers unique and substantial opportunities for improving community wide cancer control by incorporating prevention and screening practices in benefit plans; by assuring basic standards of clinical
care; by providing access to and funding for evidence-based, high
priority, institutional review board-approved clinical trials; and for
assuring some provision of end-of-life care and support.
Such laudable opportunities will not be realized automatically
and, for a variety of reasons (cost, lack of data and consumer awareness, competition among plans, etc.), are not likely to be achieved
easily. To reap the potential benefit of managed care requires data,
consensus, and will.
The ACS firmly believes there is an opportunity and a need for
gathering those data, building that consensus, and forging that will
to secure the real promise of managed care. For that reason it convened in Chicago a national conference on managed care, inviting
representatives of groups of purchasers, providers, and consumers
of oncology care. A preliminary series of planning conferences and
workshops defined the focus of the conference: to attempt to define
a basic oncology benefits package or, more precisely, the principles
that should guide the development of a such a package.
Private and public purchasers, managed care plan directors, benefit managers, consumers, providers, and ethicists contributed formal
presentations and engaged in panel sessions designed to find common ground for assuring cost control, quality-assured cancer care,
and a user-friendly health care environment. The result is a series of
statements, or principles, that the ACS believes are essential to satisfy
q 1998 American Cancer Society
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04-22-98 10:09:06
cana
W: Cancer
1990
CANCER Supplement May 15, 1998 / Volume 82 / Number 10
consumer needs when negotiating or purchasing oncology care and, if adopted by purchasers and managed care organizations, would help defuse consumer
anxiety and provide a solid basis for formulating reasonable and necessary oncology benefits in managed
care plans.
Lastly, the ACS does not pretend that the product of this conference is any more than a beginning
or partial contribution to the solution of cancer care
in managed care. One could not help but be struck
by the almost limitless variety of ‘‘models’’ advanced
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04-22-98 10:09:06
cana
by both employers and provider groups striving to
satisfy their own needs. However, the ACS does believe that convening as many stakeholders as possible is necessary to bridge the gap between expectations and reality in a cost-driven health care environment.
We shall continue to monitor carefully the evolution of cancer care and consumer needs and do
what we can through advocacy and education to
guarantee that patients with cancer and their families continue to receive the care they need.
W: Cancer
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