RD87 - Evaluation of House Bill 623: Mandated Coverage for Treatment of Malignant Brain Tumors at NCI Cancer Centers


Executive Summary:
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.

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.