Authors: Serena Yu1, Dan Liu1, Philip Haywood1,2, Mei Ling Yap3,4,5
1Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology, Sydney, NSW, Australia
2Organisation for Economic Co-operation and Development (OECD), Paris, France
3Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), The University of New South Wales, Sydney, NSW, Australia
4Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Sydney, NSW, Australia
5The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia
Given Australia is a geographically vast country researchers from the University of Technology, University of New South Wales, Western Sydney University and the OECD in France investigated how distance impacts access to healthcare. Results confirm that distance has a significant impact on people's cancer treatment decisions. The further the patient was from a radiotherapy treatment centre, the lower their likelihood of receiving treatment.
Cancer is a leading cause of death globally and nationally, with one in two Australians diagnosed with cancer by age 85 (Cancer Council, 2023). People with cancer and their families receive urgent, high-value treatment with substantial adverse events, needing to travel frequently to access extended and repeated care. In this study, we examined the impact of distance on cancer care using a quasi-experimental approach to estimate a causal effect. Study measures included patient out-of-pocket (OOP) costs, radiotherapy waiting times, whether patients were treated in a teaching hospital, and if patients received radiotherapy treatment. Results show that distance has a large and significant causal effect on the treatment decisions for cancer patients. In a context where one in two patients require radiotherapy treatment, compared to patients living within 10km of their nearest treatment centre, those living 10–50 km, 50–100 km, and over 100 km away had an 8%, 12% and 19% lower likelihood of receiving radiotherapy, respectively. Among patients who received any radiotherapy treatment, we find suggestive evidence of lower OOP costs the further the patient lived from their nearest treatment centre. This likely reflects the greater prevalence of private treatment centres in the major cities. For patients who lived in remote areas (more than 100km away from their nearest centres), we found some evidence of a lower probability of being treated in a teaching hospital, as well as longer wait times.
Our results suggest that geographic access to radiotherapy treatment explains the large variation in radiotherapy utilisation rates and should continue to be a policy priority in a country with a significant rural population. Approval of new centres should account for the importance of geographic access, especially outside of Sydney, and patient support – such as transport and provision of accommodation – should be prioritised.
Findings have significant though unsurprising policy implications in a geographically vast country such as Australia. Australia has long grappled with the policy challenges of access to healthcare outside of major cities. Given the limited health system resources, these challenges include funding and delivering the technological and workforce capabilities across regional and remote areas. Our study provides robust evidence that distance plays a significant role in clinical decision-making for cancer care. Given the high disease burden and the importance of radiotherapy as an appropriate treatment modality for most cancer patients, it is imperative that geographic access remains a policy priority. This research continues to expand and develop as we plan to include additional data as new datasets become available.