Cut Cancer With Cash
Thursday, December 13, 2018
High rates of lung cancer (indicated in this map by brown colors) are highly correlated with the Stroke Belt. (Photo credit: Wikipedia)
If you’ve read a single post here – much less the entirety of Our Healthcare Sucks – you no doubt recognize the central and predictive role that money plays in American healthcare.
Patients, employers, and the government all pay dearly for insurance coverage. Insurers, patients, and the government all pay dearly for doctor and hospital care.
Yet our results are no better than – and often far worse than – other developed countries where the money factor plays a much lesser role in their healthcare.
Maybe we’re just sending the money to the wrong players.
A couple of recent reports about the role of financial inducements in motivating patient behavior suggest we might want to start paying patients directly to reduce unhealthful behaviors and detect disease at earlier stages.
The first of these was a payment to encourage smokers to quit. A study of low-income patients – and smoking among low-income people is 67% higher than the national average at 30% vs. 18% – found that offering patients gift cards worth up to a maximum of $150 for maintaining their smoking cessation program doubled the number of ex-smokers compared to no financial inducement.
Another study of VA patients found that offering a 1-in-10 chance to win a $50 prize significantly increased patient compliance with home stool tests to screen for colon cancer.
Lung and colon cancer are public enemies #1 and 2 for cancer deaths. Anything we can do to stem their fatal tide is money well-spent.
And considering the potential for massive savings with their prevention and earlier detection, it’s money well-invested as well.
Smarter Government Spending on Healthcare
Healthcare for both groups tested is government-subsidized. This suggests that these and similar programs could be initiated for much of our highest-risk populations without securing private insurer cooperation. Although they might be induced to participate in similar efforts, it’s unproven whether such incentives would prove as effective for higher-income, privately-insured patients.
And gaining the cooperation of private insurers would require more coordination and other administrative and political hurdles than a straight-forward government initiative that would save taxpayer dollars spent on expensive cancer treatments and save millions of lives in the process.
It’s not often such simple solutions are found to be so effective in such high-risk populations. When they appear, we should pull out all the stops to roll them out across the board as quickly as humanly possible.
Can You Say “No Brainer”?
Contrast this with the multi-year campaign that finally secured coverage for CT screening for earlier lung cancer detection. This likely cost hundreds of millions of dollars to demonstrate efficacy and cost-effectiveness and will cost many times that in future screening costs that may or may not prove cost-effective and of actual human benefit – hopefully it will demonstrate both.
But this much lower-tech initiative of financially incentivizing patients – so obviously more effective in potentially preventing cancer – is missing the big-bucks vested interests the CT campaign had behind it. And when there are no lobbyists involved, little progress generally occurs.
Faced with another two years of Congressional defiance and inaction, the Obama Administration would do well to embrace such initiatives that can very likely be implemented without Congressional authorization or interference.
And wouldn’t opposition to such common sense measures amount to a pro-cancer agenda anyway?
Not even Republican antipathy toward Obama is that wrong-headed.