Using the tail to wag the dog: a consumer's perspective on management of the cost of cancer.

Abstract

This article describes the health insurance policy used by one, small, fully insured company. The most important benefits for reducing the human and financial cost of cancer are benefits that improve the decision processes of the healthy person, and a benefit that promotes involvement of a primary care physician at the time of death. These benefits in our health insurance plan are designed to: 1) assure easy access to a primary care physician; 2) provide incentives to teach the beneficiary to use the knowledge of the primary care physician as he/she makes decisions regarding care; 3) provide claims monitoring to identify small problems before they become serious; and 4) eliminate factors such as capitation and physician profiling, which provide strong financial incentives for the primary care physician to disengage from the care of seriously ill patients. Once serious illness is identified, it is important to pay generously for the person's struggle to regain health. The strategy described in this article does not rely on networks or negotiations with providers, and therefore can operate uniformly throughout the U.S. All large companies using this strategy to date have experienced a permanent drop in health care costs, largely due to a reduction in the incidence of expensive cases.