Commentary: The Cancer Care Delivery System in the 00s

Author: William T. McGivney PhD
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In this new JNCCN feature, experts will address issues and programs that will influence the delivery system for cancer care over the next decade. Individual submissions for this new section of JNCCN are most welcome. The return of substantial rates of rise in national health care expenditures, health insurance premiums, and employer contributions is beginning to make the current environment feel a lot like the health care system in the late 1980s and early 1990s. In those days, rising health care costs brought tremendous tension and pressure to bear on both employers and patients in their roles as purchasers of care. These pressures were translocated to health insurers, who were charged to reduce the pressures and, thus, sought to morph into companies that could manage health care. Hence, a managed care industry emerged. Managed care companies did have some modest and transient success in moderating the rate of rise of health care expenditures in the mid to late 1990s. The one successful mechanism used to accomplish this was a focus on aggressively negotiating down the reimbursement for services provided by facilities and by professionals. Managed care companies used the specter of provider exclusion of from “narrow networks” to extract pricing concessions. These pricing concessions from providers were achieved in the early years of the 1990s, when managed care companies rode the crest of power. However, that power began to recede in 1995. The Clinton Health Care Reform debate of 1994 provided one conclusive result, and that was the affirmation of...

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William T. McGivney, PhD, is the Chief Executive Officer of the National Comprehensive Cancer Network and a recognized expert in coverage policy and drug and device regulatory policy. Before joining the NCCN in 1997, Dr. McGivney directed the Division of Health Care Technology at the American Medical Association and worked for Aetna Health Plans as Vice President for Clinical and Coverage Policy. Awarded the FDA Commissioner's Medal of Appreciation in 1989, Dr. McGivney has served on numerous national boards and committees. He earned his PhD at the University of North Carolina at Chapel Hill and completed a postdoctoral fellowship in the Department of Psychiatry at the Harvard Medical School.

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