The impact of managed care on cancer care. Review and recommendations.

PURPOSE

The authors review the opportunities and challenges to quality cancer clinical care presented by the rise of managed care.

OVERVIEW

The impact of managed care is apparent in every aspect of cancer care: research and clinical trials, practitioner training, prevention and early detection, treatment decisions, palliation and psychosocial support, and timely referral to hospice. The little research that has been done indicates that the transformation wrought by managed care has resulted in mixed consequences for oncology healthcare providers and patients alike.

CLINICAL IMPLICATIONS

Whether cancer care will deteriorate or will improve in response to the advent of managed care depends largely on the oncology community's response. The opportunities for betterment include agreement on the quantifiable definition of excess care and the curbing of practices falling within that definition; greater emphasis on palliation and psychosocial support; flexible provider roles that may improve continuity of care and fit between patient and family need and practitioner behavior; reallocation of research dollars to reward innovation and reduce project duplication; and a diffusion of medical education into community settings.