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The rise of reimbursement-based medicine: the case of bone metastasis radiation treatment
  1. Marcos Santos1,2,
  2. Jan Helge Solbakk2,3,
  3. Volnei Garrafa2
  1. 1 Department of Radiation Oncology, Brasilia University Hospital, Brasília, DF, Brazil
  2. 2 UNESCO Chair of Bioethics, Brasilia University, Brasilia/DF, DF, Brazil
  3. 3 Department of General Practice and Community Medicine, Section of Medical Ethics, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Marcos Santos, UNESCO Chair of Bioethics, Faculty of Health and Sciences, University of Brasilia, PO BOX 04451, CEP 70919-970 Brasilia, Federal District, Brazil; marcosrxt{at}


It has been hypothesised that the reimbursement system pertaining to radiotherapy is influencing prescription practices for patients with cancer with bone metastases. In this paper, we present and discuss the results of an empirical study that was undertaken on patient records, referred to radiotherapy for the treatment of bone metastases, in a medium-size city, in southern Brazil, during the period of March 2006 to March 2014. Our findings seem to confirm this hypothesis: after a change in the reimbursement method, radiation prescriptions were adapted accordingly, in order to maximise profits. Once such patients become highly vulnerable due to their diagnoses, they also become susceptible to a subtle form of exploitation; physicians let patients believe that more radiation will be better for their health, and they do so despite knowing otherwise, and as it seems, out of pecuniary interests.

  • ethics
  • nuclear power/radiation
  • professional misconduct

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  • Contributors All authors made substantial contributions to the conception or design of the work and analysis of data for the work. All authors contributed to drafting the work or revising it critically for important intellectual content and gave final approval of the version to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board at University of Brasília.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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