Proposed Mandated Health Insurance Benefits
JLARC staff evaluate proposed health insurance mandates in support of the Special Advisory Commission on Mandated Health Insurance Benefits.
JLARC Report In Brief
Evaluation of HB 623: Mandated Coverage for Treatment of Malignant Brain Tumors at NCI Cancer Centers
House Bill 623 of the 2006 General Assembly Session would require access to treatment for malignant brain tumors at National Cancer Institute (NCI)-designated cancer centers within 300 miles of the patient's residence. There are 14 such centers, two in Virginia, and twelve in other states. The proposed mandate would not change the types of treatment available to patients with malignant brain tumors. Advocates for the proposed mandate believe that the quality of care at NCI-designated cancer centers is superior to the quality of care available elsewhere.
Medical Efficacy and Effectiveness
Evidence suggests that patients treated for malignant brain tumors at NCI cancer centers would be expected to have lower surgical mortality rates due to the high volume of surgeries performed at these centers. Studies show that patients who have brain surgery at locations where a high volume of surgeries is performed are less likely to die in surgery. However, many patients with malignant brain tumors receive treatments other than surgery. Studies have not examined whether receiving these treatments at NCI cancer centers rather than other locations results in better health outcomes.
Social Impact
Approximately 5,018 Virginians were diagnosed with a malignant brain tumor in 2005. However, only patients in health maintenance organizations (HMOs), approximately 16.5 percent of Virginia's population, would be directly affected by the proposed mandate and would potentially face major financial hardship in seeking treatment at an NCI cancer center outside their provider networks. Most Virginians with insurance already have access to NCI-designated cancer centers and choose not to use them, possibly because high-quality treatment is already available to them at other locations. In 2005, approximately 79 percent of patients with malignant brain tumors who had inpatient treatment received it through a high-volume hospital or a health provider network with at least one high-volume hospital. As mentioned previously, high volume is associated with better surgical outcomes.
Financial Impact
Overall, the proposed mandate is expected to have a modest financial impact. It could result in higher costs for treatment due to the expected increase in the utilization of NCI cancer centers and the expected higher cost at these locations. However, it appears that most Virginians already have access to quality health care and choose not to use NCI cancer centers. Therefore, the cost of health care would likely increase modestly. The monthly premium impact estimated by five respondents to the Bureau of Insurance survey ranged from $0.55 to $1.08 for mandated individual coverage, which appears to be within the range of existing mandates.
Balancing Medical, Social, and Financial Considerations
The proposed mandate is not consistent with the role of insurance because it would not fill a critical need for helping patients finance necessary health care costs. For patients with malignant brain tumors, health insurance already provides a means for addressing these costs. In addition, among those patients who have the option of receiving treatment at an NCI cancer center, many choose to receive treatment at other locations instead. Studies support the medical efficacy of having surgery at locations that perform a high volume of brain surgeries. However, many health systems and hospitals other than NCI-designated cancers perform a high volume of brain surgeries. There does not appear to be a compelling rationale for the proposed mandate even if the financial impact of the proposed mandate on the total cost of health care is modest.
| Report No. 339: Oct 2006, 36 pages | Report (pdf) | Briefing (pdf) |