The Lynx Group

Society Must Begin to Address Value

May 2012, Vol 3, No 3

At the Association for Value-Based Cancer Care (AVBCC) second annual meeting, Ira M. Klein, MD, MBA, maintained that establishing value in cancer care is not just up to healthcare strategists. AVBCC asked Dr Klein to elaborate on this idea in the following interview.

AVBCC: You mentioned that society and the individual are important components of any effort to lower cost and establish value in cancer care. How so?

Dr Klein: The issues surrounding value are really societal issues as much as they are medical and insurance issues. If you raise the visibility as to the true trade-offs in healthcare, this will be more obvious. For example, we could give a particular expensive cancer drug to one person or we could vaccinate 10,000 children against a preventable communicable disease.

When there is a societal conversation about these trade-offs, then the public becomes more reality based and rational about what is appropriate therapy. When we can refocus around the true societal costs, then we can achieve a better dialogue about value in cancer care.

AVBCC: But does the individual diagnosed with cancer, who fears for his or her life, see the situation this altruistically?

Dr Klein: Not today, but perhaps in 5 to 10 years. One of the biggest ways that individuals change decision-making is through the signals that come to them as societal pressures in the form of norms and biases. It will be a while before we get there, but I think we will make that journey. When we talk to people from Great Britain, as much as we vilify NICE (National Institute for Clinical Excellence) in the United States, we find that most people in that country are not that unhappy with the system.

What we end up doing here is exporting the horror stories about national health systems, but in Britain there is acceptance and understanding about societal trade-offs. They accept that it is okay to wait 6 months in the queue for a hip replacement, for example. They understand that this is what it takes to have a fair and equitable dissemination of healthcare.

AVBCC: Can payers help change the perception of patients toward less self-centeredness?

Dr Klein: We can, but I think we are not in the best position to do so. Payers have already been painted with the broad brush as being the ones who deny healthcare. No one understands that our margins are more like grocery stores—in the 4% to 6% range—and not like technology companies or manufacturing companies, whose profits are in the 15% to 20% range. All the public sees is that a managed care Chief Executive Officer makes X millions of dollars, but that is not restricted to our industry. This perception does not help move things forward.

AVBCC: So do we need a shift in how our own society thinks about what we, as individuals, are owed?

Dr Klein: In some ways, yes. But this goes back to our roots as a culture, where we see America as a “can do” place marked by unlimited optimism and the power of the individual.

But, if you base everything on optimism and the power of the individual, you will never want to restrict the patient’s decision to take that 1 in 100 chance of a cure, to have this come true even if it costs several hundreds of thousands of dollars and might hamper someone else’s ability to do something good for society.

Ultimately, maybe cancer treatment will not be about doing all that the patient wants, but more about doing the right thing.

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