Cost-effectiveness and reimbursement in patient care

The recent collapse of the previously effective coalition of the federal government, universities and medical schools, the pharmaceutical industry, and third-party payers has resulted in the current crisis in funding of clinical trials. The reduced financial support for clinical research comes at a time when a number of new investigational therapies offer the promise of better medical care for patients with life-threatening diseases. Controversy exists regarding the role of physicians in encouraging federal support for clinical research and third-party reimbursement for patient care for patients on clinical trials. Some believe the physician should take an activist role on the issues in general, while others believe that the physician should focus on protecting the interests of individual patients by acting as the patient's agent. Many difficult choices lie ahead for society as a whole in determining what percentage of its health-care budget will be allocated for clinical research, who will pay for patient-care costs of patients in clinical trials, and how this relatively limited resource should be distributed among the population at large. Case-management programs are one attempt to monitor and control health-care costs, but in many instances case management has been used to determine if patients are enrolled in clinical research trials and to disallow coverage for other than standard patient care.