The convenience factor

There’s a debate brewing in the Twin Cities metro area about how many radiation therapy facilities are enough.

For those who may have missed it, a story in the St. Paul Pioneer Press last week outlined the details: There’s a moratorium in 14 Minnesota counties, mainly in the metro area, on construction of new radiation treatment centers for cancer patients, ostensibly to prevent overbuilding and to hold down costs. But new facilities continue to be built in communities just outside the moratorium zone, raising questions about the validity of the argument for no new construction.

An excerpt from the article:

Critics contend the new centers amount to an argument for repealing the moratorium since they show patient needs in the metro area aren’t being met by existing centers.

“To me, it raises questions as to what is the basis for the moratorium in the first place,” said Dr. Tom Flynn of Minnesota Oncology, a physician group that was trying in 2007 to build a cancer center in Woodbury. “The important issues to address are patient access and choice, which the moratorium interferes with.”

The ban serves an important purpose, supporters say, in helping the state avoid unnecessary duplication of costly services that might ultimately drive up health costs and the premiums people pay for health insurance.

There are multiple issues entangled here: cost, consumer choice, availability of services and the free-market system embraced by the American economy. I’m going to single out only one, however – the convenience factor.

How important is it for health care services to be convenient for patients? How should we define “convenient”? Does it make a difference in outcomes when health services are more convenient for people to use? And finally, do convenience and access amount to the same thing or is there a difference between the two?

Radiation therapy facilities offer an interesting case study in these dynamics. Therapeutic radiation is a critical tool in successfully treating cancer, so it’s obviously important to ensure patients have access to this form of advanced care.

The Pioneer Press article includes an interview with a patient, Bonnie Lachman, who recently started receiving radiation treatment at a new facility near her home town of New Richmond, Wis.:

The center opened this month, and Lachman says she much prefers the three-mile drive to the new facility to the 30-mile trips she would otherwise make every day to the Twin Cities for care.

“This is a piece of cake,” Lachman said last week following the second of 33 radiation treatments she’s scheduled to receive in the coming weeks. “I was very happy to come here.”

It’s not hard to see why. Therapeutic radiation must be administered five days a week, usually for four to six weeks and sometimes longer. It can be a genuine hardship when patients have to travel for treatment, especially when they aren’t feeling well or perhaps can’t drive themselves.

To what extent, however, can patient convenience be used as one of the justifications for new facilities? The PiPress article notes there’s at least one radiation treatment center within a 20-minute drive for virtually everyone who lives in the metro area. For sure, it’s convenient, but is it essential, given the enormous price tag of building, equipping and maintaining these services?

The question takes on even more weight when you contrast this situation with rural Minnesota, where these specialized facilities are few and far between. The radiation therapy service at the Willmar Regional Cancer Center, for instance, is the only one within at least a 60-mile radius. For some patients, it’s not only an issue of an inconvenient two-hour round trip five days a week; it can also be about overall access to care. Are there patients who opt to forego radiation therapy because the travel is too much of a burden? I’m fairly certain there are.

There’s evidence that patient convenience indeed plays a role in how people seek health care or adhere to a medication regimen. A study published in 2008 in the Health Informatics Journal, for instance, supports the use of mobile technology to make it easier and more convenient for chronic diseases to be well-managed, especially among populations that are underserved. Other studies have tied the convenience factor to overuse of the emergency room, the rise in the number of retail clinics and the development of new and simpler drug regimens.

Ultimately, then, convenience matters. It seems to especially matter when there isn’t enough of it. What’s unclear, though, is whether there’s such a thing as too much convenience. Is there a breaking point at which the emphasis on convenience starts to detract from wise use of resources? These are questions that consumers and policymakers alike ought to be pondering more closely.

Photo: Wikimedia Commons

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