Impact of a New Episodic Radiotherapy Reimbursement Model on Treatment Funding and Utilization: A 5-Year Retrospective Analysis in the Brazilian Public Health System
Eronides Batalha Filho, Daniel Moore Palhares, Alexandre Arthur Jacinto, Daniel da Motta Girardi, Rodrigo Souza Dias, Gustavo Nader Marta, Samir Abdallah Hanna, Allan A. Lima PereiraPurpose
Radiotherapy access in low- and middle-income countries is constrained by underfunding. We assessed the financial and utilization impact of Brazil's 2019 transition from fragmented fee-for-service to episodic radiotherapy reimbursement in the public health system (Sistema Único de Saúde [SUS]), alongside a national equipment expansion program.
Methods
We retrospectively analyzed Brazil's national outpatient database (SIA-SUS/TabNet), covering all external beam radiotherapy treatments—complete courses, not individual fractions—in public and philanthropic facilities from May 2018 to August 2023. A pre-model reference year was compared with four post-model years for treatment volumes and reimbursed values in nominal Brazilian reais (BRL), inflation-adjusted BRL, and US dollars.
Results
Across 5 years, 657,456 treatments were reimbursed at R$2,726,816,871. In post-model year 1, volume increased by 1.6%, whereas reimbursed values rose by 29.3%, and the mean reimbursement per treatment rose from R$3,438 to R$4,375. Over four post-model years, nominal reimbursement rose by 44.7%, a 12.9% real increase after inflation adjustment; the North showed the greatest gain (82%) with a 15% treatment increase. Of the 92 procured linear accelerators, 33 were installed by 2023, increasing the capacity by 12% to 305 units; productivity reached 474.6 treatments per unit per year, below the Ministry of Health's 600-treatment threshold in every region and period.
Conclusion
Implementation of the episodic model was followed by a substantial rise in absolute reimbursement, consistent with the elimination of billing losses rather than a price change, without proportional treatment growth. Reimbursement remains far below treatment costs, and much of the gain was offset by inflation and depreciation. Equipment expansion alone does not resolve the barriers limiting radiotherapy access.