Reimbursement of interventional oncology in Australia: How it works and how it does not.

Abstract

The practice of interventional oncology (IO) embodies all the qualities that one would expect to find in a modern, value-based healthcare system. A dynamic, cutting-edge specialty like IO uses highly-targeted, minimally-invasive, image-guided techniques to deliver cost-effective, personalised medicine for cancer patients. Unfortunately, thetechnical and clinical sophistication of IO is not matched by the reimbursement models and funding arrangements in Australia to fully support this critical component of patient care. Differences between state and federal funding lead to inequity of access to 'standard of care' interventions for patients across public and private hospitals. IO procedures are poorly represented in the Medicare Benefits Schedule and often inadequately funded to cover the true costs of providing care. Complex private health fund reimbursements and inconsistent rebates for prostheses and essential equipment result in inconsistent access to important services and widely variable out-of-pocket costs for patients. IO techniques must be supported by fair, consistent and equitable funding arrangements at all levels to allow for integrated contemporary patient care; only then will the full clinical and economic benefits of IO be realised.