Palliative radiotherapy practice within Western European countries: impactof the radiotherapy financing system?

Purpose: To analyze the reimbursement modalities for radiotherapy in the di fferent Western European countries, as well as to investigate if these diff erences have an impact on the palliative radiotherapy practice for bone met astases. Materials and methods: A questionnaire was sent to 565 radiotherapy centres included in the 1997 ESTRO directory. In this questionnaire the reimbursem ent strategy applied in the different centres was assessed, with respect to the use of a budget (departmental or hospital budget), case payment and/or fee-for-service reimbursement. The differences were analyzed according to country and to type and size of the radiotherapy centre. Results: A total of 170 centres (86% of the responders) returned the questi onnaire. Most frequent is budget reimbursement: some form of budget reimbur sement is found in 69% of the centres, whereas 46% of the centres are partl y reimbursed through fee-for-service and 35% through case payment. The larg er the department, the mole frequent the reimbursement through a budget or a case payment system and the less the importance of fee-for-service reimbu rsement (chi(2): P = 0.0012; logit: P = 0.0055). Whereas private centres ar e almost equally reimbursed by fee-for-service financing as by budget or ca se payment, radiotherapy departments in university hospitals receive the la rgest part of their financial resources through a budget or by case payment (83%) (chi(2): P = 0.002; logit: P = 0.0073). A correlation between the co untry and the radiotherapy reimbursement system was also demonstrated (P = 0.002), radiotherapy centres in Spain, the Netherlands and the United Kingd om being almost entirely reimbursed through a budget and/or case payment an d centres in German), and Switzerland mostly through a fee-for-service syst em. In budget and case payment financing lower total number of fractions an d lower total dose (chi(2): P = 0.003; logit: P = 0.0120) as well as less s hielding blocks (chi(2): P = 0.003; logit: P = 0.0066) are used. A same ten dency is found for the use of isodose calculations and field set-up, but wi thout being statistically significant (P = 0.264 and P = 0.061 res.), The t ype of the centre and the reimbursement modality influence the fractionatio n regimen independently (P = 0.0274). This is not the case for the centre s ize and the reimbursement, which were found to exert correlated effects on the fractionation schedule (P = 0.1042). Conclusion: Reimbursement systems seem to influence radiotherapy practice. One should therefore aim to develop reimbursement criteria that pursue to d eliver, not only the best qualitative, but also the most cost-effective tre atments to the patients. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.