Mitchell AP, et al. - This study is the first systematic review of oncology reimbursement policies and clinical care delivery. In this investigation, researchers assessed whether the financial incentives provided by the oncology reimbursement policy affect the practice patterns of the physicians. Overall, they suggested that some oncologists might change treatment recommendations based on personal revenue considerations in certain circumstances, indicating that value-based reimbursement policies can be a useful tool to better align physician's incentives with patient needs and increase the value of oncology care.

Methods

• Investigators reviewed 18 relevant observational cohort studies assessing the relationship between reimbursement incentives and changes in reimbursement policy on oncology care delivery via systematic search of PubMed/MEDLINE, Web of Science, Proquest Health Management, Econlit, and Business Source Premier databases.
• Eligible studies included English-language articles that focused on the US healthcare system, which included empirical estimates of the association of the measurement of physician reimbursement/compensation with the delivery of cancer treatment services, and most had a moderate risk of bias.
• To assess risk of bias, The Risk of Bias in Non-Randomized Studies of Interventions tool was used.
• Date restrictions on publications were not imposed and literature searches were completed on February 14, 2018.

Results

• Heterogeneity of reimbursement policies and outcomes precluded meta-analysis; a qualitative synthesis was, therefore, conducted.
• Of the 18 studies, 15 reported a link between reimbursement and care delivery consistent with the physician's response to financial incentives, although not all studies identified such a link.
• According to findings, self-referral arrangements could increase use of radiotherapy and profitability of systemic anticancer agents could affect the choice of drugs by physicians.
• The results were less conclusive as to whether the profitability of systemic anticancer therapy affects the decision whether systemic therapy should be used.