21 – Oncology and Health Care Policy

Abstract Policies promulgated by government at the federal, state, and local levels have profound effects on virtually every aspect of the day-to-day practice of oncology. In the face of growing financial pressures, policy makers will continue to make decisions that may have tremendous impacts on the cancer community. Federal policies play a critical role in cancer research. Although the national resources devoted to cancer research remain substantial ($5.2 billion in 2016), they have not kept pace with inflation or increased scientific opportunities, and the nation is not making all of the progress it should. Legislation enacted in 2015 and 2016 increased the federal commitment to cancer research but does not overcome the impact of the combination of relatively flat funding for the National Cancer Institute since 2003 and biomedical inflation. The promise offered by new, highly effective cancer therapies has never been brighter, and as a result the benefits we are likely to realize from adequate and consistent research funding have never been greater. Policies adopted by the Medicare program regarding the prevention, diagnosis, and treatment of cancer have greatly influenced both the practice of oncology and the services available to both Medicare and non-Medicare patients throughout the United States. Both public and private insurers often rely on the coverage policies, reimbursement levels, and coding used by Medicare as a starting point for establishing their own policies. In the face of growing economic pressure, oncologists and other cancer care professionals must remain engaged in helping to inform policy makers and to shape these changes. This effort includes working to ensure that policies designed to reduce health care expenditures do not undermine access to care or the quality of care received by persons with cancer and that reimbursement for cancer care is fair and adequate. Oncologists and other cancer care specialists have unique insights involving the care of patients with cancer, and it will continue to be increasingly important to communicate these insights effectively. Policy can have a profound impact on practice, making engagement in the process not only important but also a professional responsibility.