Long-term access solutions for cancer patients

What access do/can cancer patients, survivors and conquerors have to long-term health care? What can they expect from government agencies, health maintenance organizations (HMOs), health care providers and health practitioners? What access solutions are in place and what are not?

These issues were tackled at the recent “Oncology Future Trends Forum,” a high-level discussion on developing long-term access solutions for Filipino cancer patients/survivors/conquerors. At the workshop were top officials from the Department of Health, Philippine Health Insurance Corporation (PhilHealth), Philippine Charity Sweepstakes Office, HMO representatives, oncologists, patient advocacy groups, journalists and senior Novartis (a pharmaceutical company) managers from the Asia-Pacific region. Dr. Kenneth Hartigan-Go, executive director of the Asian Institute of Management’s Zuellig Center for Asian Business Transformation, was the forum facilitator. Hartigan-Go was a great information source for the media when he was still with the University of the Philippines and the Bureau of Food and Drug Administration (now Food and Drugs Administration).

The workshop should provide rays of hope for those still battling the life-threatening disease and those staying healthy after the battle. A key objective was to understand public and private health care funding and policies as well as the needs of the stakeholders and the factors that influence their decision-making process. What are to be considered health care priorities and how do they apply to the treatment of patients?

One of the speakers, Dr. Eduardo P. Banzon, president and CEO of PhilHealth, provided a compassionate view of what many cancer-stricken Filipinos undergo because of “chronic health inequity.” He asked: “How many times have we heard horror stories of patients choosing to succumb to cancer because they cannot afford treatment?”

Banzon said that PhilHealth believes in a “comprehensive, customer-oriented approach.” Financial risk protection (FRP), he said, covers four bases. It should provide the opportunity to claim benefits. It should ensure access to facilities where health care is paid for. It provides significant financial support. It realizes higher availment and utilization. He cited Thailand and Mexico, model countries in pushing universal health care.

Banzon was quite gung-ho about designing and rolling out a benefit package for what he called catastrophic illnesses (cancer, among them) that would give patients a reasonable choice, provide quality care and services and make PhilHealth give a support value of 100 percent for sponsored members and at least 50 to 75 percent for non-sponsored PhilHealth members. These will be sourced from reserves of P3 billion and eventually to be funded through increased premiums.

Yes, increased premiums. You want more, you pay a little more. Banzon brought out a scheme not too easy to understand. He explained that “primarily sponsored members” would enjoy no-balance billing or zero co-payment, while cases previously treated as charity cases would be subsidized. The great promise is that “no one gets left behind.” That the package will eventually be available to all, but “with a corresponding co-payment scheme depending on income class.”

I must say that the actuarial jargon and the figures could be mind-boggling, but I could sense from the discussions a clear desire to help the ailing, particularly the ailing poor. Aristides Merida Jr. of Insight Tech Systems Management Corp. spoke on “Healthcare Financing Infrastructure for Cancer Care.” He said that “the rich get the most for the least payment, while the poorest get the least for the highest payment.” Quite intriguing, but when he explained how, you’d see why. The rich have financial risk protection packages to draw from and hardly pay for anything. The poor have only their empty pockets. Picture how the moneyed make more money, while the poor get mired in debt.

And when will all those words become reality? A simple question that begs for a yes answer: Could late-stage cancer prevention—through early detection—be covered by HMOs and PhilHealth? A yes is a win-win answer.

Now for something directly beneficial to those who will be facing cancer and the costly therapies. I rarely mention profit-making companies but worth mentioning is the “Embrace Time Program,” a first-of-its kind partnership between Philam Life and leading HMOs to create a funding mechanism for expensive cancer treatment. The program is available via a company’s employee coverage benefits through partner HMOs.

Also worth citing is Novartis Oncology Access (NOA), “an innovative shared-contribution access program” that evolved from the Glivec International Patient Assistance Program (Gipap). Launched in 2002, Gipap is a comprehensive direct-to-patient assistance that has provided 50,000 patients worldwide with effective treatment for cancer, among them, Philadelphia-positive chronic myeloid leukemia, gastrointestinal stromal tumor, acute lymphoblastic leukemia and dermatofibrosarcoma protruberans. Gipap was launched in the Philippines in 2003.

Norvartis Healthcare Philippines helps NOA-enrolled patients complete their treatment by donating the portion of the full-year imatinib/nilotinib (cancer drugs) treatment that the patients cannot afford to pay for. For NOA beneficiaries who are unable to contribute even a portion, Novartis shoulders the full-year cost.

NOA marked its ninth year last March with 500 cancer conquerors, their families and caregivers making the one-kilometer “Walk-for-Life” at the QC Circle.

Contact Novartis Oncology Program at www.novartis.com or Christine Fajardo, market access and corporate affairs director, at 3687005.

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