{"entity":{"id":"idea-fund-course-based-radiotherapy-payment","kind":"idea","name":"Pay per course of radiotherapy, not per session, so short courses are not penalised","aka":[],"tldr":"Hospitals are paid for each radiotherapy session, so a proven five-session course earns less than an unproven twenty-five-session one. Paying per course removes the reason to give more treatment than needed.","summary":"Payers move from per-fraction to episode-based or per-course payment for radiotherapy, with the price set by indication and independent of fraction number, and with a quality bonus for adherence to evidence-based fractionation guidelines. Randomised trials (FAST-Forward, CHHiP, PACE-B, the Dutch and Canadian hypofractionation trials) have shown that shorter courses are equivalent for breast and prostate cancer, yet uptake lags for years in fee-for-service systems. The US Radiation Oncology Model was designed on this principle; implementing it widely, and in other countries, aligns payment with evidence and frees capacity.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Surgery and radiotherapy cure most, get least): Sullivan et al., Global cancer surgery (Lancet Oncology Commission 2015)","url":"https://doi.org/10.1016/S1470-2045(15)00223-5"}],"tags":[],"related":["idea-fund-radiotherapy-trials-infrastructure","idea-fund-payer-funded-pragmatic-trials"],"cancers":["breast-hr-positive","prostate"],"sections":[],"technologies":["imrt-igrt","sbrt"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-surgery-radiation-innovation","b-incentive-misalignment"],"keyPapers":["paper-sullivan-lancet-oncol"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Course-based payment raises the use of guideline-concordant hypofractionation for breast and prostate cancer by at least 20 percentage points within two years in affected systems, with no measurable change in outcomes or toxicity.","rationale":"Uptake of hypofractionation is far higher in capitated or salaried systems (UK, Canada) than in fee-for-service settings, indicating payment, not evidence, drives practice. Episode payment is a standard tool for aligning incentives and requires no new evidence.","test":"Compare hypofractionation rates and outcomes before and after episode-based payment in a payer region against a matched fee-for-service region.","maturity":"being-tested-at-scale","actor":"payer","cost":"small","horizonYears":2},"route":"/ideas/idea-fund-course-based-radiotherapy-payment/","neighbours":{"idea":[{"id":"idea-fund-radiotherapy-trials-infrastructure","kind":"idea","name":"Core-funded radiotherapy trials infrastructure with central quality assurance","route":"/ideas/idea-fund-radiotherapy-trials-infrastructure/"},{"id":"idea-fund-payer-funded-pragmatic-trials","kind":"idea","name":"Payers fund trials of cheaper, shorter or lower-dose versions of expensive treatments","route":"/ideas/idea-fund-payer-funded-pragmatic-trials/"}],"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"technology":[{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"}],"bottleneck":[{"id":"b-incentive-misalignment","kind":"bottleneck","name":"Incentives reward me-too drugs and marginal gains","route":"/bottlenecks/b-incentive-misalignment/"},{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"paper":[{"id":"paper-sullivan-lancet-oncol","kind":"paper","name":"Global cancer surgery: delivering safe, affordable, and timely cancer surgery","route":"/key-papers/paper-sullivan-lancet-oncol/"}]}}