Benjamin P. Falit

Cancer-Specific Outcomes Among Young Adults Without Health Insurance

PURPOSE The Patient Protection and Affordable Care Act (ACA) will likely improve insurance coverage for most young adults, but subsets of young adults in the United States will face significant premium increases in the individual market. We examined the association between insurance status and cancer-specific outcomes among young adults. METHODS We used the SEER program to identify 39,447 patients age 20 to 40 years diagnosed with a malignant neoplasm between 2007 and 2009. The association between insurance status and stage at presentation, employment of definitive therapy, and all-cause mortality was assessed using multivariable logistic or Cox regression, as appropriate. RESULTS Patients who were uninsured were more likely to be younger, male, nonwhite, and unmarried than patients who were insured and were also more likely to be from regions of lower income, education, and population density (P < .001 in all cases). After adjustment for pertinent confounding variables, an association between insurance coverage and decreased likelihood of presentation with metastatic disease (odds ratio [OR], 0.84; 95% CI, 0.75 to 0.94; P = .003), increased receipt of definitive treatment (OR, 1.95; 95% CI, 1.52 to 2.50; P < .001), and decreased death resulting from any cause (hazard ratio, 0.77; 95% CI, 0.65 to 0.91; P = .002) was noted. CONCLUSION The improved coverage fostered by the ACA may translate into better outcomes among most young adults with cancer. Extra consideration will need to be given to ensure that patients who will face premium increases in the individual market can obtain insurance coverage under the ACA.

Specialty Medications: Traditional And Novel Tools Can Address Rising Spending On These Costly Drugs

Spending on specialty medications, which represented a small proportion of US pharmacy spending at the beginning of this decade, is growing by more than 15 percent annually. It is expected to account for approximately half (

Supply and Demand for Radiation Oncology in the United States: Updated Projections for 2015 to 2025

235 billion) of total annual pharmacy spending by 2018. Among the numerous reasons for the high cost of this heterogeneous group of medications are the increasing size of target patient populations, the high cost of drug development, and a complex and uncoordinated delivery system. In this article we describe the evolution of the specialty market, characterize the current state of specialty medication use, and articulate key challenges and potential solutions. Fully realizing the potential value of the expanding universe of specialty medications will require collaborative efforts to reduce waste and promote value. Those who prescribe, dispense, deliver, and pay for specialty medications will need to employ a combination of traditional and novel management approaches, such as prior authorization, step therapy, tiered formularies, administration at lower-cost sites, and the unique tools being developed for cancer medications.

Ensuring Accuracy Within the Medicare Physician Fee Schedule: An Example From Radiation Oncology

PURPOSE Prior studies have forecasted demand for radiation therapy to grow 10 times faster than the supply between 2010 and 2020. We updated these projections for 2015 to 2025 to determine whether this imbalance persists and to assess the accuracy of prior projections. METHODS AND MATERIALS The demand for radiation therapy between 2015 and 2025 was estimated by combining current radiation utilization rates determined by the Surveillance, Epidemiology, and End Results data with population projections provided by the US Census Bureau. The supply of radiation oncologists was forecast by using workforce demographics and full-time equivalent (FTE) status provided by the American Society for Radiation Oncology (ASTRO), current resident class sizes, and expected survival per life tables from the US Centers for Disease Control. RESULTS Between 2015 and 2025, the annual total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 19%, from 490,000 to 580,000. Assuming a graduating resident class size of 200, the number of FTE physicians is expected to increase by 27%, from 3903 to 4965. In comparison with prior projections, the new projected demand for radiation therapy in 2020 dropped by 24,000 cases (a 4% relative decline). This decrease is attributable to an overall reduction in the use of radiation to treat cancer, from 28% of all newly diagnosed cancers in the prior projections down to 26% for the new projections. By contrast, the new projected supply of radiation oncologists in 2020 increased by 275 FTEs in comparison with the prior projection for 2020 (a 7% relative increase), attributable to rising residency class sizes. CONCLUSION The supply of radiation oncologists is expected to grow more quickly than the demand for radiation therapy from 2015 to 2025. Further research is needed to determine whether this is an appropriate correction or will result in excess capacity.

The Bush Administration's Health Care Proposal: The Proper Establishment of a Consumer-Driven Health Care Regime

The authors suggest that one solution to ensure CMS pursues its policy goals separately from its RVU-setting initiative would be for Congress to reign in the ACA and codify a directive to preferentially use empirical data.

Biosimilar Competition In The United States: Statutory Incentives, Payers, And Pharmacy Benefit Managers

Benjamin P. Falit In his State of the Union address on January 31, 2006, President George W. Bush asserted: “for all Americans, we must confront the rising cost of care, strengthen the doctor-patient relationship, and help people afford the insurance coverage they need.” Soon thereafter, the White House National Economic Council released a summary of President Bush’s plans for health care reform.1 The Bush plan argues that increased consumer control over health care purchasing decisions will go a long way to solving America’s health care woes. By making patients more value-conscious consumers, the Bush Administration hopes to reduce costs, improve quality and increase competition within the health care sector. The problem of rising health care costs is not new. In fact, President Bush’s statement could have come from any American President in the last fifty years. Consider, for example, former President Jimmy Carter’s comments on the “health care crisis” in his 1979 State of the Union Address: “We must act now to protect all Americans from health care costs that are rising

Design and Implementation of Bundled Payment Systems for Cancer Care and Radiation Therapy

1 million per hour, 24 hours a day, doubling every 5 years. We must take control of the largest contributor to that inflation: skyrocketing hospital costs.”2 National health care expenditures as a percentage of GDP have been steadily climbing since the 1960s, and there is no indication that they will level off in the near future.3 Even after adjusting for inflation, the average cost of an employer-provided, family health insurance plan has increased from just over

The Radiation Oncology Job Market: The Economics and Policy of Workforce Regulation

6,000 per year in 1999 to almost

Role of the Resident as a Teacher (RAT) in the Medical Student (MS) Clerkship: A Report From the Radiation Oncology Education Collaborative Study Group

11,000 per year in 2005.4 More than one-quarter of adults report problems paying medical bills, and over sixty percent of those reporting problems have health insurance.5 Each year, nearly 750,000 American families, a number that represents a twenty-fold increase in filings over the last two decades, file for bankruptcy because of a major illness.6 The financial pressures created by medical inflation may have contributed to policymakers ignoring an arguably more important issue: the quality of health care services.7 Although the United States spends more per capita on health care than any other country, Americans’ health status lags far behind that of other nations.8 Out of thirteen comparably industrialized countries, the United States ranks an average of twelfth on sixteen well-accepted health indicators such as years of potential life lost and age-adjusted mortality.9 The World Health Organization (WHO) has developed a measure entitled “performance on the level of health,” which reports “how efficiently health systems translate expenditure[s] into health as measured by disabilityadjusted life expectancy.”10 According to the report released by the WHO in 2000, the United States ranks 72nd in the world on this index.11