National Health Insurance
Provider Initiative for Making Treatment more Affordable
Download full PDF Document
In my opinion, a good example of the way in which healthcare providers should be responding to affordability constraints and thinking about their practice under a future National Health Insurance system is the Independent Clinical Oncology Network (ICON), an oncology managed care group.
The rationale for ICON has been that “the cost of oncology treatment is rising sharply due to technological advances; the number of cancer cases (is) increasing sharply as people grow older and live longer;” and to deal with difficulties in access to oncology treatment for patients on low cost medical scheme options where the limits had previously made standard oncology care unaffordable.
“The basis of the ICON network is strict adherence to protocols that are driven by treatment intent.” Two years ago the doctors re-organised their business model, in consultation with funders and suppliers, so that it has become possible to provide an improved package of radiotherapy and chemotherapy services to more low income patients than was previously available.
ICON aims “at providing care equivalent to best available in public sector facilities”; uses a network of private facilities distributed geographically across the country (there are currently 18 units countrywide with an additional 7 being planned); “allows patients to have immediate access to care with no waiting lists; and at costs that compare favourably to public sector”.
ICON uses “case management, utilization management, independent medical evaluations and medical bill review” in order to ensure that care is delivered appropriately. “In the insured market, ICON is typically aimed at lower benefit options. ICON is aiming to improve access for those currently enjoying limited access to cancer services in the private sector. ICON is also ready to accept and roll out its services to the patients of government health authorities.”
|
