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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Cost-effectiveness and reimbursement in patient care
K H Antman1, L M Aledort, J Yarbro
1Harvard Medical School, Dana Farber Cancer Institute, Boston, MA 02115.
Abstract:
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.
Insights
Funding for clinical trials is in crisis due to a collapsed coalition. This impacts access to novel therapies for critical illnesses, raising questions about physician roles and healthcare budget allocation.
Area of Science:
- Medical Research Funding
- Health Policy
- Clinical Trials
Background:
- A critical coalition supporting clinical trials (government, academia, industry, payers) has dissolved, leading to a funding crisis.
- This occurs as promising new therapies for life-threatening diseases emerge, highlighting the need for continued clinical research.
- Physician roles in advocating for research funding and patient care reimbursement are debated, with differing views on activism versus patient advocacy.
Purpose of the Study:
- To examine the impact of coalition collapse on clinical trial funding.
- To explore the ethical considerations and societal choices regarding clinical research investment and patient care costs.
- To analyze the role of case management in clinical trial enrollment and coverage.
Main Methods:
- Analysis of the current funding landscape for clinical trials.
- Discussion of the societal implications of resource allocation for health research.
- Examination of the function and impact of case-management programs in clinical research.
Main Results:
- The dissolution of key partnerships has created a significant funding shortfall for clinical research.
- Difficult societal decisions are required regarding the proportion of healthcare budgets for clinical research and patient care costs.
- Case management, intended for cost control, can restrict access to clinical trials and non-standard care.
Conclusions:
- The current funding crisis threatens the development of innovative medical treatments.
- Urgent policy and societal discussions are needed to ensure sustainable clinical research and patient access.
- Careful consideration of case management's role is necessary to avoid hindering patient participation in vital clinical trials.
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