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Senate inquiry into options for cancer treatments

Country: 
Australia
Partner Institute: 
Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney
Survey no: 
(6)2005
Author(s): 
Kees van Gool
Health Policy Issues: 
System Organisation/ Integration, Quality Improvement, Remuneration / Payment, Responsiveness
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes no no no no no no
Featured in half-yearly report: Health Policy Developments Issue 6

Abstract

In June 2005, the Australian Senate Community Affairs Committee released a report, titled "the cancer journey: informing choices". The committee was made up of 2 Senators from the governing coalition parties, 3 from the opposition party and 1 independent. The report examines the key areas of multi-disciplinary and integrated service delivery and the use of complementary and alternative treatments. It made 33 recommendations aimed at improving treatment choices and outcomes for cancer patients.

Purpose of health policy or idea

Australia's health care system is often accused of being fragmented and uncoordinated. This is said to create real quality and access problems for patients with illnesses such as cancer which require care over extended periods of time, by multiple providers in a variety of public and private care settings. The Senate report aims to highlight those issues and recommend ways in which they can be addressed. The overarching focus of the recommendations is to provide patients with more information about available treatment and support services, and to create greater financial incentives for providers to offer multidisciplinary care.

Main points

Main objectives

In cancer care there often appears to be a dichotomy between the doctors and patients attitudes towards treatment options; doctors tend to stick with scientifically proven treatments whereas patients are often looking for the most promising options in order to improve their odds. However, lack of data and the cost of less conventional or adjuvant therapies creates frustration and uncertainty for patients too. The Senate inquiry aimed to shed some light on these issues and look at these problems from the point of view of patients.

Type of incentives

The report's recommendations create a number of incentives. In particular the recommendations call for:

  1. further fee-for-service incentives for providers to participate in multidisciplinary care in both the community and hospital setting.
  2. Accreditation processes be developed and implemented for cancer-related service organisations. Thereby creating quality incentives for patients to seek treatment at accredited institutions and for providers to be accredited.
  3. The use of and adherence to clinical guidelines is an essential component of accreditation.
  4. A directory of all cancer-related services be developed and made available to providers and consumers so that patients have greater information about the range of services  available to them.

Groups affected

Cancer-care patients, Cancer-care providers

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual consensual highly controversial
Structural or Systemic Impact marginal rather marginal fundamental
Public Visibility very low high very high
Transferability strongly system-dependent rather system-neutral system-neutral

Obviously it is too early to tell, but the recommendations have the potential to make a significant difference to the information that patients are given and are designed to give them more power over their treatment and care options.

Political and economic background

In the 2004 federal election campaign, the Government offered a range of new policies related to cancer care. This included the establishment of new national agency called Cancer Australia.  Its role, in part, will be to bring together the plethora of cancer-related organisations, services and interest groups and make recommendations to the Federal Government on cancer policy and priorities.

Following the government's re-election, the Australian Senate referred the following matters to the Community Affairs Committee, on the motion of Senator the Hon. Peter Cook, to inquire and report on:

  1. the delivery of services and options for treatment for persons diagnosed with cancer.
  2. how less conventional and complementary cancer treatments can be assessed and judged.

The Senate report, brought down in June 2005, makes several recommendations on the future role of Cancer Australia. 

Senator Cook was diagnosed with late stage melanoma in August 2004 and has now retired from the Australian Senate.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes no no no no no no

Origins of health policy idea

During its inquiry the Senate Community Affairs committee received 113 submissions from a range of organisations, individuals and Commonwealth and State health departments.

Previous reports by various organisations such as the Cancer Council of Australia, the Clinical Oncological Society of Australia and the National Cancer Control Initiative have identified the need for a more consumer driven approach to cancer care, including greater coordination of cancer services.

The reforms recommended in the report are not new but the Australian parliament has provided a means for these recommendations to be considered at a national level - across party lines.

Initiators of idea/main actors

  • Parliament

Approach of idea

The approach of the idea is described as:
renewed: The previous reports by cancer-related organisations identified above were first published between 2001 and 2003

Stakeholder positions

A number of cancer organisations, including the Cancer Council of Australia, made public statements to endorse the Committee's report. The Senate report received very favourable and relatively extensive media attention.  

It is not clear what the Australian Medical Association's (Australia's main provider association) views on the recommendations are. 

Actors and positions

Description of actors and their positions
Parliament
Opposition and independent senatorsvery supportivevery supportive strongly opposed
Government Senatorsvery supportivevery supportive strongly opposed

Influences in policy making and legislation

Given that the report was unanimously endorsed by the Committee, it is likely that the Government will formally respond to the recommendations. 

If a formal response is made, the Government is likely clarify which recommendations it supports and provides details of how it plans to implement those recommendations. The influence, if any, of the legislative process will become clearer after this.

Legislative outcome

pending

Actors and influence

Description of actors and their influence

Parliament
Opposition and independent senatorsvery strongneutral none
Government Senatorsvery strongstrong none
Opposition and independent senatorsGovernment Senators

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

A formal response to the Senate report is likely to contain further information about the Government's intention to adopt and implement the recommendations.

Monitoring and evaluation

Not applicable

Results of evaluation

Not applicable

Expected outcome

The report was released in June 2005 and the Government is as yet to formally respond to the report's recommendations. It is therefore premature to make an overall assessment of the policy.

However, in the context of the Australian health care system it is difficult to instigate change without the support of the conventional medical fraternity.  Yet, a large number of the recommendations contained in the report relate to complementary medicine as well as allied health and psychosocial support services.

There is therefore a risk that in developing more detailed policy statements arising from the report's recommendations, support amongst conventional providers will evaporate if they perceive a threat to their funding or status.

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable four system more equitable

The recommendations have the potential to empower consumers and create greater incentives for providers to respond to the patient needs and wishes.  The recommendations also make specific provisions for more equitable access to services in rural and remote areas and the indigenous population.

References

Sources of Information

Community Affairs References Committee. The cancer journey: informing choices, Report on the inquiry into services and treatment options for persons with cancer. June 2005. report available at http://www.aph.gov.au/senate/committee/clac_ctte/cancer/index.htm

Author/s and/or contributors to this survey

Kees van Gool

Suggested citation for this online article

Kees van Gool. "Senate inquiry into options for cancer treatments". Health Policy Monitor, October 2005. Available at http://www.hpm.org/survey/au/a6/3