Third-party payer reimbursement policies have undergone significant changes in recent years and will probably continue to do so as the nation's health care system is reformed. These changes will have important implications for oncologists, similar to those that have arisen as a result of Medicare's payment system changing from one of "reasonable charges" to a fixed-fee schedule. The likely growth of managed competition as part of health care reform may prove to be disadvantageous to the oncologist without laws or rules guaranteeing cancer patients the right to treatment by a specialist and to tertiary care. Other areas of importance that will probably be affected include reimbursement of patient care costs associated with clinical trials and of drug costs when the drug is used for off-label indications.