PubMed · 1045550
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L Weile. 1976-01-07. [Entry into nursing].. https://pubmed.ncbi.nlm.nih.gov/1045550/
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Canada's provinces have some of the most highly developed cancer control systems in the world, but the recent crisis in waiting times for radiotherapy has drawn attention to many weaknesses and inadequacies. Focusing on the province with the largest cancer control system, Ontario, this paper explores the historical origins of current problems in cancer control and shows that they are directly related to policy decisions made in the early years of the system. The development of cancer control in Ontario from the 1920s to the present is outlined, and the historical origins of 3 specific problems related to patient care are discussed: fragmentation of care, which has resulted from an emphasis on radiotherapy rather than comprehensive care and from tensions between the medical profession and government; variation in practice, which can be traced to the empirical origin of much cancer treatment and the slow implementation of research programs; and inequitable access to care, which can be attributed to the emphasis on geographic centralization of services. Attempts to reform Ontario's cancer control system are unlikely to be successful unless these fundamental issues are recognized and addressed.
BACKGROUND: Kaiser Permanente (KP) is a large health maintenance organization (HMO) operating in 14 states and caring for 8,000,000 members in hundreds of facilities staffed by thousands of physicians and support personnel. Cancer care is provided to these KP members as part of the health care package. METHODS: KP insures members for all their health care needs and provides needed services in their own facilities except in rare circumstances. Professional services are provided by physicians of the Permanente Medical Groups, locally governed groups of physicians contractually bound to Kaiser Permanente by capitation agreements. These agreements cover the full range of services for cancer and all other diseases. KP uses evidence-based guidelines to rationalize the provision and delivery of medical care for its members. A large investment in technology has allowed these guidelines to be generally available on local intranets and has facilitated the development of a computerized medical record and linkages to multiple clinical and administrative databases for all providers. Several of the KP regions have strong commitments to research in the public domain and have integrated this effort into the clinical practice of oncology, particularly in clinical trials in cancer treatment and prevention. Research efforts also exist in the areas of cancer epidemiology and outcomes. RESULTS: Cancer care is integrated fully into the comprehensive medical care provided the KP member. Health benefits cover the full range of cancer prevention and treatment without distinction by diagnosis. CONCLUSIONS: Within the broad range of health care options in the U.S., KP represents a good example of the value of a large HMO to deliver comprehensive general medical and oncologic care.