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The National Tariff: How Chemotherapy May Be Funded
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The National Tariff: how chemotherapy may be funded
Anne Hines, Lead Pharmacist, Merseyside and Cheshire Cancer Network
Introduction
NHS drug budgets have long been a source of contention and frustration for all involved. Cancer chemotherapy is no exception,1 and funding decisions will become even more difficult as the number and cost of new regimens increase.
For new treatments, an important step on the road to funding is appraisal by the National Institute for Health and Clinical Excellence (NICE), but there are considerable delays between drug licensing and NICE approval, and some high-cost chemotherapy drugs may never be prioritised for assessment. Furthermore, even when NICE gives the go ahead, mechanisms for funding are still required.
Payment by Results is one method for funding clinical services in the NHS.
Payment by Results
Payment by Results has three components:
- A National Tariff for reimbursement of activity
- A method for describing clinical activity
- A method for counting clinical activity
There are certain advantages to the system. For example:
- Providers are paid for actual activity
- Money should follow the patient, wherever the treatment is given
- The system should drive up quality by facilitating patient choice
- Financial systems should be transparent
One disadvantage of Payment by Results is that payment, and hence income, is driven by activity and is not dependent on outcome measures; however, this policy is under review.2
The Payment by Results system is underpinned by a series of clinical classifications known as healthcare resource groups (HRGs)—standard UK groupings of clinically similar treatments that use a common level of healthcare resource.3 Activity is defined by codes issued by the Office of Population Censuses and Surveys (OPCS), and is recorded by clinical coders. Groups of OPCS codes are clumped together to form an HRG and a tariff is paid every time an activity is performed. OPCS codes have recently been published to support the implementation of Payment by Results in several new clinical areas, including chemotherapy and radiotherapy.3
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Discussion.