Debating the oncologist's role in defining the value of cancer care: we have a duty to society.

Abstract

Unsustainable Increases in Health Care Spending The rising costs of health care in general and cancer care in particular have prompted increasing concern in recent years. Data from the Organisation for Economic Co-operation and Development suggest that health care expenditure as a percent of gross domestic product is not only higher in the United States than in other developed nations but is also rising at a steeper rate. In 2011, the United States spent a staggering 18% of gross domestic product—$2.7 trillion— on health care. Although some have been optimistic that the rate of growth is finally slowing, perhaps reflecting the impact of payment reforms and the Affordable Care Act, experts warn that the evidence is more consistent with the effects of the recent recession and one-time changes that will not ultimately result in a long-term flattening of the cost curve. Cancer care accounts for a substantial share of health care spending and appears to be growing even faster than health care costs overall; US expenditures for cancer care were $72B in 2004 and $126B by 2010. Evidence suggests that this increase reflects not only those advances in early detection, prevention, and treatment that have led to improvements in cancer mortality but also the increasing use of aggressive therapy near the end of life, raising concerns that increases in cost have not been accompanied by commensurate improvements in quality. Although we as oncologists recognize that measures such as expenditures in the last months of life are imperfect, most of us also have direct experiences that validate the underlying concern that we do not always direct scarce resources optimally. Many have voiced concerns about the potential impact of this pattern of health care spending on economic stability and, somewhat ironically, population health within the United States. The substantial and increasing share of resources devoted toward health care inevitably crowds out other types of essential spending. This includes education and social services which, like health care, have an important impact on population health.