Issue 19 / 27 May 2013

ACCESS to essential radiotherapy services in this country is not equitable. Cancer patients living in non-metropolitan areas or on the outskirts of large cities are disadvantaged.

Radiotherapy is a one of the pillars of anticancer treatment, along with chemotherapy and oncological surgery, and the best outcomes are seen where management plans are determined through multidisciplinary care.

Significant disparities have been found in cancer outcomes between patients living in metropolitan and non-metropolitan regions. Those living away from big cities have a significant decline in quality-of-life scoring because of factors such as long distances to travel for treatment, being away from family and support networks during treatment, and the financial burden of travel and relocation.

About one in three cancer patients who could benefit from radiotherapy miss out — which is significant considering about 50% of patients require radiotherapy as part of best-practice treatment for cure or palliation of their cancer.

A number of reasons have been postulated as to why these patients miss out, including the patient’s decision to decline treatment because of lack of convenient access to treatment facilities and lack of understanding of, and referral for, appropriate treatment options regarding radiotherapy.

Radiotherapy has undergone rapid technological advancements in the past couple of decades, and can now cure some cancers. It can also have a greater impact on stopping cancer cells reproducing compared to chemotherapy.

Cancer is the second most common cause of death in Australia, after heart disease, and is a leading chronic disease, with one in three people affected by age 75 years, and the incidence increasing as the population ages. The cost of managing the cancer burden is escalating, with predictions that health care could drain half of government spending by 2050.

Although individual providers can offer bulk-billing for patients with limited ability to pay, there is general concern about out-of-pocket expenses. Medicare benefits cover less than 75% of the cost of radiotherapy treatment and private health insurance does not cover outpatient radiotherapy. A fully bulk-billing private radiotherapy practice would not be sustainable, even though most care providers undertake bulk-billing and discounts for pensioners and special needs groups.

While private facilities can fill the radiotherapy gap, particularly those that can utilise the resources of a national network to provide technology and treatments in areas of greatest need, funding this access en masse requires a strong public and private system to create balance for patients and funders in the sustainable provision of treatment.

To address this, governments are implementing strategies that include hybrid private–public partnership models. These models also provide material savings for governments on capital expenditure and recurrent costs like salaries, maintenance and back-office support when using private providers.

Private providers are usually required to meet strict key performance indicators as part of any contracted service, yet existing public hospital cancer services are not subject to the same scrutiny.

GenesisCare — the largest private provider of radiation oncology services in Australia — in WA is an example of a public–private partnership. In 2011 it won contracts to carry out radiotherapy services at three public hospitals, which, added to its private facilities, has about doubled access to non-discretionary radiotherapy in that state in the past 18 months. GeneisCare has estimated that the partnership will save the WA government more than $200 million in recurrent and capital costs over the next 10 years.

The hybrid private–public model demonstrates the benefits of a healthy interdependence between two previously quite separate segments.  As well as financial savings to government, patients benefit from increased access to non-discretionary health care, improved survival rates and, where a cure is not possible, palliation for pain relief resulting in a better quality of life.

Dr Raphael Chee is the GenesisCare Shenton House Director of Cancer Services and an assistant professor at the University of WA School of Surgery. GenesisCare is a private provider of radiation oncology services participating in a number of public–private partnerships.

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