U.S. medical research is the envy of the world. No other nation has produced so many life-saving and life-enhancing technologies in the past three decades.
One reason we have cured many childhood cancers and developed clot-busting heart attack drugs is because the research is well-funded with federal money and support from two important private industries: health insurers and drug companies. Now, health insurers want to take their money off the table.
The health insurance industry, including managed care plans such as health maintenance organizations, no longer wants to pay to have patients treated in medical research called clinical trials.
Clinical trials are studies where new treatments, such as a new drug for cancer that is not yet approved by the Food and Drug Administration, are compared with treatments that are already in use. Clinical trials offer patients the most advanced treatment available. In diseases such as cancer and AIDS, they frequently are a patient's last chance.
The insurance industry's turnabout is a dramatic shift in philosophy because the industry used to pay for clinical trials. But now, cost pressures in competitive managed care markets have led to cost-cutting. If there is less financial support for clinical trials, we will have fewer studies, fewer new treatments and a lot less knowledge about which medical practices are best.
The change in insurers' thinking is purely financial, and it attempts to shift to the federal government and drug companies costs that insurers once covered. Financial support for clinical trials comes in two parts.
First, there are costs to run the study. These include the costs of the drugs being studied, diagnostic tests related specifically to the research and costs related to administering the trial (for example, gathering and analyzing patient data). Government agencies, such as the national Institutes of Health (NIH), or drug companies pay for this. No one is asking insurers to pick up any of these costs.
The second group of costs are routine patient care costs, which include doctor visits, nursing care, hospital stays and laboratory tests. Patients in clinical trials receive these routine medical services regardless of whether they get the new, unapproved drug or the drug already in use.
Also, patients get this routine care if they are not in a clinical trial, in which case the insurer will pay for it without question. Thus, routine patient care costs to insurers are the same whether or not patients are in the clinical trial.
