Impact of prospective payment models on cancer patient care: a systematic review

Background: Cancer care faces increasing sustainability challenges due to the structural growth of health care costs, driven by longer survival, expanding treatment indications, and the rapid diffusion of high-cost technologies. In this context, policymakers have implemented prospective payment systems (PPS) as policy strategies to promote care coordination, efficiency, and resource optimization in oncology. Objective: To evaluate the association between the implementation of PPS and key outcomes in cancer care, including health care expenditure, service utilization, quality of care, and patient survival or mortality, compared with fee-for-service (FFS) payment models. Methods: We conducted a systematic literature following PRISMA guidelines. Eligible studies, published between 2000 and 2024, assessed PPS mechanisms in adult cancer patient populations, mostly using cohort and case–control studies. We synthesized evidence across four predefined domains: health expenditures, service utilization, quality of care, and survival or mortality. Results: Across included studies, findings were heterogeneous and context dependent. Nine studies evaluated health expenditures, of which 90 % reported reductions. Among six studies assessing service utilization, 66.7 % found no significant variation. Eleven studies examined quality outcomes; 54.5 % reported improvements. For survival, 57.1 % of seven studies showed favourable results. Conclusion: Our review synthesizes the evidence on the implementation of PPS applied to cancer care compared with FFS models. PPS are consistently associated with cost containment, while evidence regarding utilization, quality, and survival remains mixed and, in some cases, inconclusive. Our findings underscore the potential of PPS as a policy instrument to improve financial sustainability in oncology, while also highlighting the need for careful design, implementation, and monitoring to mitigate unintended risks.