Access to non-reimbursed anti-cancer treatments: an interview study on in-hospital practices and policies and moral perspectives of hospital executives in the Netherlands

Anti-cancer treatments that have entered the market are not always immediately covered by basic health insurance in countries with publicly funded healthcare systems. This confronts hospital executives with ethical dilemmas, for instance whether to use hospital budgets to pay for non-reimbursed treatments or allow patients to pay for treatments out of pocket. To our knowledge, no empirical research has been conducted on in-hospital policies regarding non-reimbursed treatments in countries with publicly funded healthcare systems. This study examines policies and practices regarding access to non-reimbursed treatments in hospitals across the Netherlands, and the moral perspectives of hospital executives. A qualitative research approach was chosen. Interviews were carried out with hospital directors, board members, hospital managers and heads of departments in the Netherlands ( N = 17), and thematically analyzed. Respondents expressed concerns regarding the rising costs of newly approved anti-cancer treatments and healthcare costs in general. While in some hospitals, treatments were occasionally paid for using hospital budgets, in other hospitals, this did not occur. In some hospitals, respondents actively assisted physicians in finding alternatives ways of gaining access to non-reimbursed treatments. In other hospitals, access to non-reimbursed treatments was not facilitated. In general hospitals, patients were often referred to academic hospitals if relevant treatments were not (yet) reimbursed. While respondents had differing views on out-of-pocket payments, most respondents supported a strong egalitarian ethos that places high value on equal access. Practices, policies and hospital executives’ perspectives on access to non-reimbursed anti-cancer treatments vary amongst hospitals in the Netherlands. This might lead to variability in access to non-reimbursed anti-cancer treatments among Dutch patients.