Nancy Davenport-Ennis

Cancer patients today confront cost-shifting burdens from insurers, reduced  availability of employer insurance and tiered copayments for services and drugs.  Additionally, patients face reduced lifetime caps on health insurance policies  and annual caps on services, such as maximum allowable funding for specific  tests or treatments, such as radiation. Such complexity often results in a lack  of access.

The Patient Advocate Foundation responded to 6.3 million requests from July  2005 through June 2006 from patients, caregivers and healthcare professionals  seeking assistance in navigating the healthcare system. We helped reverse  insurance coverage denials; negotiate pre-authorizations for complex therapies  and/or medication; coordinate benefits between dual health plans covering one  patient; negotiate resolutions to medical debt crisis; and mediate complex job  retention issues. Seventy-six percent of our patients have health insurance, but  they represent underinsured patients who have health insurance that won’t pay  for prescribed treatment. Because they are insured, they are often ineligible  for public and private assistance.

Complexity in accessing needed pharmaceutical drugs fueled 33 percent of PAF  requests for services in 2005. For the 24 percent of PAF patients who were  uninsured in 2005, the foundation negotiated free or subsidized drugs through  pharmaceutical assistance programs or state Medicaid programs. In that same  year, copayment burden resulted in almost 4,000 patients receiving financial  support through the PAF Co-Pay Relief program (

). Urgency and  desperation define the level of trauma these patients are facing.

Oncologists are facing complexities of their own regarding how to provide  services in community offices for seniors when the level of drug reimbursement  frequently totals less than their cost to purchase the drugs. Many physicians  must transfer Medicare patients to hospitals for treatment, resulting in higher  costs to the system and personal burden of sometimes daily travel requirements  that necessitate a family member or friend to be available for every visit.  Frequently, seniors we help simply stop treatment and die of their disease. A  76-year-old Pennsylvania retiree told us he opted out of therapy because of no  available caregiver support. A 41-year-old man in New York City contacted PAF as  his journey with cancer was ending. He had also stopped therapy with no support  available and no financial resources to pay for assistance at home.

While recent Medicare changes to cover prescription drugs for seniors sought  to reduce the complexity of drug access for seniors, all stakeholders in the  healthcare area must do more. This includes patients, nonprofits, healthcare  providers, employers, insurers and government. We must diligently focus on  reducing health disparities, solving the uninsured crisis and restoring moral  integrity to our nation as we seek to assure sustained access to healthcare for  all Americans.

Our vision at PAF is a healthcare delivery system that is available to every  person diagnosed with a debilitating illness. Ultimately, our goal is to see a  nation that treats every patient as a family member. If we made healthcare  decisions as though each decision would be applied to our child, spouse, parent  or sibling, the decisions would be compassionate and correct.

So how do we do that with the financial constraints that plague employers,  individuals, state and federal health programs? The answer may lie in our  nation’s priorities. Together, we have an opportunity to make healthcare a  national priority, understanding that we each have a stake in making it work,  and we must be willing to personally invest in a successful solution.

—Nancy Davenport-Ennis is a breast cancer survivor and the chief  executive officer and founder of the Patient Advocate Foundation (800-532-5274,  

) and National Patient Advocate  Foundation (202-347-8009, 

Articles

Nancy Davenport-Ellis, a breast cancer survivor and founder of the Patient Advocate Foundation, discusses the expense of cancer care for patients and the complexities of health insurance, Medicare, and Medicaid. 

Nancy Davenport-Ennis

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