Do our healthcare models undermine the promise of advanced radiotherapy?

While proton therapy offers exquisite dose control, bringing it to patients isn’t just about physics.

Public‑sector proton centers are often tethered to universities and academic hospitals, leading to giant facilities with giant price tags (north of US$250m). Multi‑room installations routinely cost US$100-200m and even single‑room systems run about US$30m. Such publicly funded projects can focus on outcomes rather than ROI, yet politics and construction timelines mean they emerge slowly and only where governments have the appetite to subsidize them.

Private initiatives move faster and aim to make equipment smaller and more efficient, but their survival hinges on revenue. In the US, fewer than 1% of radiotherapy patients are treated with protons, and reimbursement remains patchy. Many privately financed proton centers have struggled to generate sufficient returns on their heavy capital investments, as patient ramp-up is slow and reimbursement remains inconsistent.

When public models are too slow and private models can’t hit ROI targets, everyone loses, especially the patients. How do we reimagine adoption pathways so that innovation isn’t strangled by bureaucracy on one side and economics on the other?

- David