THE VHI’S decision to remove cover for diagnostic scans for some cancer patients has been condemned by a leading oncologist who said it is causing unnecessary anguish for sick and vulnerable people as part of a “misguided” attempt to save money.
The VHI confirmed that it had changed its criteria for allowing members access to Pet (Positron Emission Tomography)/-CT scans but insisted it had done so because of a “routine review” and not in an effort to reduce costs.
It said last night it would meet consultant radiologists next week to discuss the changed criteria after which it would review the level of cover offered.
The scan, which costs about €1,800, is more sophisticated than regular diagnostic scans and can tell if irregular masses are active cancer or scar tissue. It can also detect secondary cancers. If a patient is being considered for surgery for a localised cancer, such a scan can assess if it has spread, something which would rule out any prospects of a cure.
Leading oncologist and Senator Dr John Crown told The Irish Timesthat the VHI was taking "the most narrow view" of who needed the scans. He said in recent months he had "noticed a real change" in approval rates for the diagnostic tool and said he was now engaging in extensive correspondence with the insurer in which he had to justify the need for scans. He said some people who he believe needed the scans were being denied them while the VHI was granting approval for others but only after long delays which put them through weeks of unnecessary anguish.
Dr Crown said sometimes the only way a consultant could tell if there were secondary cancers which would make surgery pointless was through such a scan.
“You don’t want to put someone through unnecessary surgery and a scan can make that outcome avoidable. This is an area where it seems easy to economise and easy to say yes or no but they do not see the long-term financial implications of saying no.”
The company said, in response, that the changes were made “to ensure the proper and appropriate use of these technologies. The money we spend on Pet/CT scans has increased year on year. In 2007 we spent €2 million on Pet/CT scans and this has now increased to €3.5 million in 2010”.
It said that in the context of its overall spend on cancer care of €227 million in 2010, it was “not an area where we would see big savings and it’s an area we would expect to see spending increase”.
Earlier this month, the VHI was accused of steering cardiac patients away from costly but non-invasive treatments and of putting lives at risk by offering diminished cover for a highly regarded heart valve-replacement procedure at private hospitals.
In January it downgraded the Parents and Kids schemes to which it switched many families in 2009 and reduced cover for certain orthopaedic and ophthalmic treatments to 80 per cent of the total cost if performed in a private hospital. That move could leave a person facing a shortfall of at least €4,000 on some treatments
The company also rolled out price increases of up to 45 per cent at the beginning of the year and followed it up with a 2 per cent increase announced last week.
