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St. Paul, Minn. – The Minnesota Center for Health Care
Ethics today released a report on ethical perspectives on
coverage decisions under managed care. The report includes
the results of the Center's year-long series of forums, held
in the Twin Cities and Greater Minnesota, that placed stakeholder
participants in decision making roles in managed care organizations
in order to elicit their views on coverage for "experimental
interventions" (procedures not yet proven to be medically
safe and effective for the general population).
The forums were intended to help participants understand
how managed health care plans currently make coverage decisions
and to seek input on how this kind of decision-making could
be improved. Participants reviewed two cases on coverage of
experimental treatment, one a policy choice, and the other
an individual patient request for an exception to a coverage
policy.
Results include:
- Participants felt that health plans, rather than government,
should make coverage decisions.
- Participants believe health plans are doing a good job
of making health care coverage decisions.
- Both professional and lay Minnesotans believe that health
plans should not, as a matter of policy, automatically cover
all experimental interventions.
- Participants agreed health plans should continue to use
medical research in deciding whether or not to cover emerging
or experimental treatments.
- Participants think there should be flexibility in making
exceptions to overall policies but exceptions should be
based on compelling evidence that an experimental treatment
shows promise for a participant.
- Participants favored additional coverage for participation
in clinical trials by patients for whom an emerging treatment
shows strong promise.
Participants also made suggestions about how health plans
can improve health care coverage decision-making. They suggested
that health plans try to do a better job of explaining why
and how they make decisions about coverage; engage the public
in discussions about coverage decisions; and explore working
with others to fund promising clinical trials of interest
to enrollees.
"The results were consistent regardless of audience
or location," says Karen Gervais, Ph.D., a medical ethicist
and forum co-facilitator. "Participants struggled with
the issues as much as health plans do when faced with the
complexities surrounding coverage decisions for experimental
interventions."
The Minnesota Council of Health Plans funded the Minnesota
Centers' project as part of its EQUIP program, a multi-year
initiative to improve health plan ethics, quality, consumer
information and prevention through public education and greater
public and community involvement in health care decision-making.
Michael Scandrett, executive director of the council, has
said, "Minnesota's health plans have done a great job
of using managed care to improve quality and expand prevention,
while keeping health care affordable. However, we haven't
done as good a job of explaining how managed care works. The
ethics forums have provided considerable support for current
decision-making processes, and have built a foundation to
improve managed care decision-making, which is what EQUIP
is all about."
Sponsored by Fairview Health System, HealthEast Care System,
the College of St. Catherine and the Sisters of St. Joseph
of Carondelet, the Minnesota Center for Health Care Ethics
is an academic, clinical and policy consortium. The Minnesota
Center conducts collaborative research, seminars and conferences
on health care reform, faith and cultural diversity, end of
life decision-making and emerging technologies.
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Note: For more information or to receive the final report,
"A Role-Playing Exercise in Managed Care Decision Making,
Coverage for Experimental Interventions, March 1999,"
contact the Minnesota Center for Health Care Ethics at (651)
690-7895 or visit the Center's website at www.stkate.edu/mnethx.
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