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REVIEW – WEISS (2016)
COST OF A LYMPHEDEMA TREATMENT MANDATE –
10 YEARS OF EXPERIENCE IN THE COMMONWEALTH OF VIRGINIA

One of our most urgent societal problems today is our inability to afford quality healthcare. Treatment of chronic illness accounts for over 90% of Medicare spending. Chronic lymphedema places over 3 million Americans at risk of recurrent cellulitis, yet without convincing predictions of the costs and benefits of lymphedema treatment, insurers are reluctant to fully cover treatment of this common condition.

This paper presents, for the first time in the open literature, non-proprietary authoritative cost and utilization data for the treatment of lymphedema from an insurer's perspective. It can be useful to insurers considering coverage of lymphedema treatment, and to legislators concerned with the cost of a lymphedema treatment mandate.

Two state legislatures have been successful in enacting lymphedema mandates, Virginia in 2003 and North Carolina in 2009. The Virginia Code has provisions for reporting the costs of every health mandate, and it is the series of these reports for the first 10 years of the lymphedema treatment mandate that is the basis of this review. This collection of annual reports, which includes the annual costs of the lymphedema treatment mandate in Virginia, constitutes the most complete, non-proprietary population-based data set known to the author that documents the actual cost of lymphedema treatment.

Actual claim cost and estimated health care insurance premium impacts of lymphedema treatment are shown to be a miniscule part of the cost of a health insurance contract. The Virginia data confirmed previous clinical data that the treatment of lymphedema results in lower medical costs and fewer hospitalizations. This is a potent model for reduction in healthcare costs while improving the quality of care for cancer survivors and others suffering with this chronic progressive condition.

The uncorrected, unformatted version of this paper may be found here
Cost of Mandate (http://www.lymphactivist.org/cost_rev_4.pdf)

For a definitive version of this work, please refer to the published source:
DOI 10.1186/s13561-016-0117-3.
http://healtheconomicsreview.springeropen.com/articles