As new drugs appear and costs rise, funding cancer treatments is an increasingly pressing question for employers, insurers and the general public. We asked six experts for their vision for the future.

BUPA DEPUTY MEDICAL DIRECTOR DR PAULA FRANKLIN

"We fund cancer in full from diagnosis to palliative care, partly because our members tell us that's what they want. But it's becoming ever more expensive.

"We have a function called Horizon Scanning to look at new drugs and different modes of treatment and what the outcome will be on our business and our members. "Increasingly treatments are being added rather than replacing old ones, but while we are concerned it is becoming more expensive, other conditions that we cover are becoming less expensive.

"Ophthalmology and cataract procedures were more complex operations in the past. We want to use the benefits from that to fund new drugs. We did that quite successfully with our MRI network, driving cost savings through efficiencies and diverting that money to fund cancer drugs.

"However, even with efficiencies in other parts of our business, it is probably not sustainable without passing on significant costs to customers. Therefore we are actively looking at new options in co-operation with our customers.

"Some competitors have policies that are less expensive and offer less cover. If we are going to make a trade off between the price of the procedure and the amount of cover we offer we want to make sure our customers understand it so they are not disappointed if they are ill.

"It is unlikely we will come up with anything this year, but it is a pressing issue."

AXA PPP HEALTHCARE HEAD OF MEDICAL POLICY DR GARY BOLGER

"Advances in treatment are transforming cancer to a manageable condition. Key to this has been smarter drugs that interfere with the way that cells communicate - like, Herceptin and Avastin.

"While they are already here and licensed, many more drugs are in the pipeline. This is good news for patients but many are very expensive and in some cases patients need to take them for a long time. This is the crux of the funding challenge facing healthcare providers.

"NHS managers will have to make tough decisions as they try to balance patients' demands for finite resources.

"Private medical insurers need to respond to the challenges posed by the new cancer drugs. For AXA PPP's part we have changed our policies to include long-term cancer treatment, with choice of length of coverage. This puts customers' entitlement on a clear footing rather than leaving them subject to insurers' discretion.

"When it comes to cost, not every employer can afford or will pay to cover all of these new treatments for as long as they might be needed.

"To enable them to include cancer cover while managing their exposure to open ended claims, we offer three levels of cover (cancer treatment for up to one year, three years or as long as the member's oncologist recommends)."

WATSON WYATT SENIOR HEALTHCARE AND RISK CONSULTANT ELLIOTT HURST

"Assuming a claimant's cancer is being treated privately for a limited period using a licensed drug, not yet available on the NHS, what options are there when privately insured coverage ceases?

"Purchasing such drugs privately is not generally a viable option to the majority of the population. The claimant is left in a difficult position at a time where their physical health rather than treatment financing should be the priority concern.

"New insurer models are required. Such models might be based on some form of NHS top-up option, to plug the gap between licensed drugs and those available on the NHS. Alternatively, they might be based on some form of upgrade to the core cancer benefit that the employer is willing to provide.

"Most employers are not willing to operate an open chequebook on employee health, and insurers need to focus on the gaps between the combination of NHS and employer programme provision, and employee demand.

"Cancer may well be the first example of a greater sharing in the costs of treatment between the state, the employer and the employee. This is a challenge, yet also an opportunity for innovation and forethought. From an employer perspective, such forethought would also need to be underpinned by appropriate governance based decision making processes."

IMPERIAL COLLEGE SCHOOL OF MEDICINE, PROFESSOR OF CANCER MEDICINE AND HONORARY CONSULTANT ONCOLOGIST KAROL SIKORA

 "Aging populations with a wide range of medical problems are consuming increasing amounts of care. New drugs and procedures are powerful inflationary drivers in an information rich, consumer world. A recent study showed that new cancer drug use in Britain was consistently below that of our EU neighbours. But money talks and preference walks.

"There is evidence of a growing use of top-up payments to break access barriers in the NHS. Politicians are in denial about their existence and reluctant to get involved in debate. But cancer patients are beginning to become very sophisticated consumers of extra clinical services.

"Is it time to open the debate about whether the NHS should allow patients to contribute or insure for improved services for themselves and their families? This could reduce the inequity resulting from the current confusion where some patients have to receive all their care privately. This is unaffordable to many who have paid their tax-based insurance premium to the NHS for the core package. Being open about the possibilities could lead to a set of innovative insurance products to pay for specific options.

"Mycancerdrugs.co.uk from WPA is the first of such policies. This could herald an era of real patient choice. "How much we are willing to pay for an extra year of good quality life with cancer is going to be a key question, and how individuals can contribute to their care in an equitable way.

"We are impinging on the core of NHS doctrine - care given freely on the basis of medical need and not ability to pay. Its high priests are now very worried for we can never return to an age of innocence."

WPA HEAD OF COMMUNICATIONS CHARLIE MCEWAN

"Gaps in NHS care are increasing - approval from the National Institute for Health and Clinical Excellence (NICE) is required before most PCTs make advanced therapies available, however, NICE approval is no guarantee of NHS availability.

"The NHS will continue to ration treatment. Postcode lotteries will remain and the Scottish Medicines Consortium is likely to continue approving treatments ahead of and independently to NICE.

"So in the mid-term the choices for funding cancer treatment in the UK appear to be: rely on traditional treatments on the NHS; hope that the NHS will make some advanced drugs available under public pressure; go to Scotland for treatment; or pay for these advanced therapies privately - self fund or funded through insurance (either PMI or NHS cancer top-up plans).

"Most employees are unaware of how much private treatment can be. A few years ago the average cost of a cancer claim used to be less than twenty thousand pounds and now commonly exceeds one hundred thousand pounds.

"WPA's solution is NHS top-up cancer cover, mycancerdrugs, which is aimed at employees without PMI cancer cover. It covers advanced life saving therapies denied by the NHS with a low premium of one's age per year.

"It is likely companies will look at these new forms of top-up cancer cover as an enhanced employee benefit in addition to or instead of hospital cash plans."

CANCER BACKUP CHIEF EXECUTIVE OFFICER JOANNE RULE

"NHS cancer care is generally good, although there are problems. If the public thought that the NHS could not look after you if you had cancer, then it would be in trouble. Most politicians understand this and I don't believe there will be changes in the funding of cancer care for the foreseeable future. I can imagine that co-payments might extend from eyes, teeth and prescription charges but I can't see co-payments as a fair or sensible way to fund cancer care.

"One of the hallmarks of a half-way decent society is surely that it cares for those with a life-threatening disease? But that still leaves us with the difficulties. Because postcode prescribing and slow access to new cancer treatments are real concerns, private medical insurance (PMI) is potentially an important employee benefit. For employees who want to work during some of their treatment, it is easier to schedule your appointments and treatment to suit your working life if you have PMI. But some PMI policies are more equal than others and employers need to ask the right questions before they purchase cover.

"Cancerbackup - with CIPD and Working With Cancer - publishes guidelines for employers and will soon publish guidance on purchasing PMI."