Medical treatment

Forum: Create a national body to quickly decide on medical treatment in exceptional cases

I was alarmed to read the article, “Cancer patient received another blow – insurer refuses to pay for drugs” (April 21). A patient was diagnosed with a rare cancer, and after a poor response to standard therapies, her oncologist treated her with a cocktail of drugs including a drug approved in Singapore to treat another cancer. She answered well, but the insurer refused the claim for this medicine, citing its lack of approval by the Health Sciences Authority for the cancer she had. There are important political implications arising from this case.

Health care resources are limited and doctors and patients cannot be given carte blanche to choose from all therapies – we all suffer when health care premiums skyrocket, and they will if health care costs are not well managed.

However, practice guidelines are generally developed for the most common conditions and even then for the most common forms of treatment. When patients have exhausted these forms of treatment, or when there are no guidelines, it is impossible that no other treatment can be offered due to reimbursement restrictions.

As medicine advances, each of us will come to be seen as unique and will benefit from “precision medicine” approaches based on a person’s genes.

If population-level guidelines are not appropriate for specific cases due to genetic or other unique traits, how can we meet the needs of this patient group?

There will also always be exceptional cases where standard guidelines and policies would be ill-suited, and urgent decisions with substantial financial impact would need to be made. Who should make these decisions and how can the process be efficient, consistent, fair and timely?

A national “clearinghouse” for such clinical decisions is needed. The relevant experts could then be mobilized quickly to decide on the advisability of an expensive and non-standard treatment that is prescribed.

Escalating health care costs are a concern, but we should all be equally concerned about the denial of inappropriate care.

Jeremy Lim (Dr)