がんの科学と治療

Impact of Changes in National Healthcare Legislation and Financial Cuts by Insurance Companies on use and Evaluation of Psycho-Oncological Care

Abstract

Adriaan Visser, Anne Vennix and Margot Van Der Doef

1.1 Objective: To study the impact of changes in national healthcare legislation and financial cuts by insurance companies on inflow of clients and their evaluation in psycho-oncological aftercare. These legislation changes and financial cuts did lead to a more complex in-take processes and less free-of-charge psycho-oncological care against higher costs. The psychosocial care concerns individual, cognitive behavioural, and art therapy. 1.2 Method: Two groups of clients were formed, based on financial policy cuts in 2012/2013 (N=334) and 2014/2015 (N=360). Data was part of the annual evaluation by De Vruchtenburg (Psycho-oncological Centre, Rotterdam, the Netherlands). The questionnaire was filled at home after the therapy, returned postage free. Analyses applied ANOVA, Mann-Whitney and MANOVA tests. 1.3 Results: Results showed that due legislation changes and financial cuts fewer cancer clients visited the centre in 2014/2015 as compared to 2012/2013. In 2014/2015, clients were more frequently women, relatives and older patients, got therapy longer time after medical diagnoses, with more unknown prognosis. The measures led to delay in seeking psycho-oncological care. Clients in 2014/2015 evaluated more negatively their treatment compared to 2012/2013, regarding information about therapy, participation in choosing fitting therapy, and the counselling in general. Separately evaluation of the individual, cognitive behavioural and therapy gave identical results. 1.4 Conclusions: Psycho-oncological care became less accessible due to higher cost, as a result of national legislation policy and financial cuts in healthcare insurance. European studies should be promoted to increase insight into changing national financially thresholds for seeking psycho-oncological care.