Insurance Coverage Gaps for Proton Therapy: Vulnerable Patient Populations

Abstract

radiation oncologist for every 130-300 new radiation oncology patients per year, with at least one Linear Accelerator (LINAC) for every 250-400 patients that require treatment. Aims: Describe at the national and subregional level the available infrastructure and medical human resources at radiation oncology facilities in Chile estimating the current infrastructure gap and future needs according to expected population and cancer incidence growth to year 2025. Materials/Methods: Department heads of every radiation oncology units in the private and public sector in Chile were individually contacted to collect information on Full Time Equivalent (FTE) radiation oncologists in their center, number, and age of radiation oncology units and total number of radiation oncology courses delivered in each center. Population estimates for ear 2025 where retrieved from the national statistics institute. Cancer incidence estimations where extracted from the National Cancer Registries. Results: In 2018 Chile has 22 radiation oncology facilities with 41 operative LINACS and 74 FTE radiation oncologists (FTE), amounting to 4,1 radiation oncologists for every 1 million inhabitants. In year 2017 one FTE treated on average 220 annual patients. There are 2,51 LINACS for every 1000 treated patients, treating 397 annual patients on average. Of the 41 LINACS operative in the country, 15 of them have been operative for more than 10 years and could reasonably be considered in need of replacement in the near future. Interestingly, 10 of the 15 obsolete LINACS are in the private sector, which has 25 LINACS, which means private clinics have been slower to update their infrastructure than the public sector. With an estimated cancer incidence of 216.9 every100.000 people the current need is approximately 62 LINACS and 80 FTE. Estimating incidence to year 2025 a total of 68 LINACS and a minimum of 88 FTE would be required to meet national needs. Conclusion: Chile currently has a reasonable physician radiation oncology staffing but is lacking on treatment units and replacement of obsolete units. By 2025 an almost doubling of the total number of LINACS will be required considering the need for replacement of obsolete units if Chile is to compare to international standards of care.