Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, Rotterdam, The Netherlands.
Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
AJOB Empir Bioeth. 2022 Oct-Dec;13(4):275-286. doi: 10.1080/23294515.2022.2110963. Epub 2022 Aug 26.
When anti-cancer treatments have been given market authorization, but are not (yet) reimbursed within a healthcare system, physicians are confronted with ethical dilemmas. Arranging access through other channels, e.g., hospital budgets or out-of-pocket payments by patients, may benefit patients, but leads to unequal access. Until now, little is known about the perspectives of physicians on access to non-reimbursed treatments. This interview study maps the experiences and moral views of Dutch oncologists and hematologists.
A diverse sample of oncologists and hematologists (n = 22) were interviewed. Interviews were analyzed thematically using Nvivo 12 qualitative data software.
This study reveals stark differences between physicians' experiences and moral views on access to anti-cancer treatments that are not (yet) reimbursed: some physicians try to arrange other ways of access and some physicians do not. Some physicians inform patients about anti-cancer treatments that are not yet reimbursed, while others wait for reimbursement. Some physicians have principled moral objections to out-of-pocket payment, while others do not.
Oncologists and hematologists in the Netherlands differ greatly in their perspectives on access to expensive anti-cancer treatments that are not (yet) reimbursed. As a result, they may act differently when confronted with dilemmas in the consultation room. Physicians working in different healthcare systems may face similar dilemmas.
当抗癌治疗已获得市场授权，但在医疗体系内尚未（获得）报销时，医生会面临伦理困境。通过医院预算或患者自费等其他渠道来安排获得这些治疗可能使患者受益，但会导致获得机会不平等。到目前为止，人们对医生对获得未报销治疗的看法知之甚少。本访谈研究旨在描绘荷兰肿瘤学家和血液学家对获得未报销治疗的看法和体验。
我们对多样化的肿瘤学家和血液学家（n=22）进行了访谈。使用 Nvivo 12 定性数据分析软件对访谈进行主题分析。
本研究揭示了医生在获得未报销的抗癌治疗方面的经验和道德观点之间存在明显差异：一些医生试图安排其他获得途径，而另一些医生则不这样做。一些医生会告知患者有关尚未报销的抗癌治疗，而另一些医生则等待报销。一些医生从原则上反对自费支付，而另一些医生则不反对。
荷兰的肿瘤学家和血液学家在获得昂贵的未报销抗癌治疗方面的观点存在很大差异。因此，他们在咨询室面对困境时可能会采取不同的行动。在不同医疗体系中工作的医生可能会面临类似的困境。
