Defining experimental therapy - a third-party payer's dilemma
Article Abstract:
Most insurance companies and third-party payers of medical costs will not reimburse the cost of experimental medicine. On the surface, the rationale is sound; if an academic physician wants to evaluate the merit of a new idea, a clinical trial should be funded through traditional granting agencies. However, problems arise because there is no uniformly agreed upon definition on what constitutes experimental. The public perceives that the category 'experimental' is probably applied to any new technology that the insurers perceive to be too expensive. Furthermore, patients are likely to feel cheated if their insurer refuses to reimburse a procedure that their physician has told them might help. On the other hand, insurers do not feel obligated to support any technique a physician might choose to try, no matter how expensive or how remote the chances for success are. One possibility is that the supported procedures can be listed explicitly by the insurers, thereby removing any vagueness. This approach would require frequent updates of the list, as new techniques make their way into the mainstream of treatment. Another possibility is to provide riders on the policies, which will cover new procedures at an additional cost. It is to be expected that a seriously ill patient will want any treatment available, regardless of the cost. The degree to which members of the public are willing to pay for new procedures when they are healthy may be a more objective measure of the public opinion. Ideally, decisions on medical treatment should be left to the medical community, but complete consensus on any one medical issue is unlikely. Even well-accepted procedures continue to be discussed and reevaluated as the medical field changes. It should be obvious that consensus alone cannot be the criterion for deciding which treatments are standard and which are experimental. At present, such issues are generally hidden within the details of an insurance contract. They need to be brought out into the open so that the insurers, the medical community, and the patients can work together to determine what may be expected from new treatments and how they are to be financed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1990
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Electroconvulsive therapy - a modern medical procedure
Article Abstract:
Electroconvulsive therapy may be an effective method for treating severe forms of depression. This treatment was originally developed for treating patients suffering from schizophrenia, but was later used to treat patients with severe depression. Electroconvulsive therapy is most successful in patients with severe depression who are suffering from delusions and psychomotor retardation. It should be used to treat individuals suffering from disorders requiring a more rapid response, such as suicidal or catatonic patients. Others who should receive this type of therapy include those who cannot be treated with drugs or those who do not respond to other types of treatment. Some researchers believe that electroconvulsive therapy should be offered earlier during the course of treatment to patients with depression. The dosage given to patients receiving electroconvulsive therapy should be carefully chosen to insure treatment success.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1993
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Disseminated melanoma - is there a new standard therapy?
Article Abstract:
The global increase of invasive primary cutaneous melanoma has made it a growing public health problem. In the United States, it is increasing at a faster rate than any other cancer. In 1992, experts predict 6,700 deaths in the United States. Primary prevention consists of public education to avoid excessive sun exposure, particularly in childhood. Screening programs, secondary prevention, detect early disease. Surgical excision is the single curative therapy for early primary melanoma. Physicians and patients must examine the skin to look for suspicious lesions. After the disease has spread there is no single recommended treatment. Quoting Dr. Chekov's play, 'The Cherry Orchard', "When a lot of different remedies are suggested for a disease, that means it can't be cured."
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1992
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