Many people in the USA cannot find cancer treatment. The government also wants to change how it pays for medical tests.

許多美國人無法獲得癌症治療。政府也希望改變醫療檢查的給付方式。

Many cancer clinics are closing. Over 50 million people live in areas with no radiation clinics. This is a big problem for people in the country. In cities, there are many clinics. In the country, if one clinic closes, people have no other place to go.

許多癌症診所正在關閉。超過 5,000 萬人居住在沒有放射治療診所的地區。這對鄉村地區的人們來說是一個大問題。在城市裡，診所很多。但在鄉村，如果有一間診所關閉，人們就沒有其他地方可以前往。

Small clinics and poor areas have the most problems. These clinics do not have much money. They close more often than big hospitals.

小型診所和貧困地區的問題最嚴重。這些診所資金不足，關閉的頻率比大醫院更高。

The government wants to pay less money for X-rays and MRI scans in 2027. They want to save money. But some doctors are worried. They say hospitals will have less money and might close more clinics.

政府希望在 2027 年減少 X 光和 MRI 掃描的給付金額。他們希望節省開支。但一些醫生感到擔心，他們表示醫院的資金將會減少，可能會導致更多診所關閉。

People in the country have less cancer care. New government rules might make this problem worse.

鄉村地區的人們獲得的癌症護理較少，新的政府規定可能會使這個問題更加惡化。

Recent data show that radiation oncology services are becoming less available across the United States. This trend is happening at the same time that the federal government is proposing changes to how outpatient services are paid.

最近的數據顯示，美國全國的放射腫瘤治療服務正逐漸減少。與此同時，聯邦政府正擬議更改門診服務的支付方式。

A study in the International Journal of Radiation Oncology*Biology*Physics shows a steady decrease in access to radiation therapy between 2018 and 2025. According to the data, over 50 million people live in counties that have no radiation oncology centers. There is a major difference between cities and rural areas; while cities usually have several options, the closure of one facility in a rural county often means local residents lose all access. This problem is most serious for independent centers that are not part of a hospital, as they lack the money to survive financial difficulties. Furthermore, these closures are more common in areas with lower average incomes and more uninsured patients.

刊登於《國際放射腫瘤學、生物學與物理學雜誌》的一項研究顯示，2018 年至 2025 年間，放射治療的獲取機會穩步下降。根據數據，超過 5,000 萬人居住在沒有放射腫瘤中心的縣。城市與鄉村地區之間存在重大差異；城市通常有多個選擇，但鄉村縣若有一間設施關閉，往往意味著當地居民將失去所有獲取機會。這個問題對於不屬於醫院的獨立中心最為嚴重，因為它們缺乏應對財務困難的資金。此外，這些關閉情況在平均收入較低且未投保患者較多的地區更為常見。

At the same time, the Centers for Medicare & Medicaid Services (CMS) has proposed a 2027 rule to introduce 'site-neutral' payments for imaging services like X-rays and MRI scans. This policy aims to stop paying hospital-owned departments more than independent doctors for the same services. While CMS expects this to save the government $260 million and reduce costs for patients by $70 million, many organizations oppose the plan. Critics argue that these cuts could make hospitals financially unstable, especially in poor regions, which might cause even more services to close.

與此同時，美國醫療保險和醫療補助服務中心 (CMS) 擬定了一項 2027 年的規定，旨在為 X 光和 MRI 掃描等影像服務引入「地點中立」支付方案。此政策旨在停止讓醫院旗下部門在提供相同服務時獲得比獨立醫生更高的支付額。雖然 CMS 預期這能為政府節省 2.6 億美元，並為患者減少 7,000 萬美元的成本，但許多組織反對該計劃。批評者認為，這些削減可能會導致醫院財務不穩定，尤其是在貧困地區，可能會導致更多服務關閉。

Experts have emphasized that these two pressures are happening at once. Dr. Vivek S. Kavadi from ASTRO noted that access was already declining before the 2026 payment cuts, which suggests the healthcare network was already fragile. To solve this, some have suggested new laws, such as the Radiation Oncology Case Rate (ROCR) Act, to create a more stable financial system for healthcare providers.

專家強調，這兩種壓力是同時發生的。來自 ASTRO 的 Vivek S. Kavadi 博士指出，在 2026 年支付削減之前，獲取機會就已經在下降，這顯示醫療網絡早已脆弱。為了le解決這個問題，有人建議制定新法律，例如《放射腫瘤個案率 (ROCR) 法案》，為醫療服務提供者建立一個更穩定的財務制度。

The United States is facing two main problems: a lack of cancer care in rural areas and a shift toward new payment models that may threaten the survival of healthcare providers.

美國目前面臨兩個主要問題：鄉村地區缺乏癌症治療，以及轉向新的支付模式可能會威脅到醫療服務提供者的生存。

Recent data indicate a contraction in radiation oncology availability across the United States, coinciding with proposed federal adjustments to outpatient reimbursement structures.

近期數據顯示，全美放射腫瘤科的可用性正在縮減，這與聯邦政府擬議調整門診報銷結構的時間相吻合。

An analysis published in the International Journal of Radiation Oncology*Biology*Physics reveals a systemic reduction in radiation therapy access between 2018 and 2025. The data indicate that over 50 million citizens reside in counties devoid of radiation oncology practice sites. A critical disparity exists between urban and rural environments; while urban centers typically maintain redundant treatment options, the closure of a single facility in a rural county frequently results in the total eradication of local access. This vulnerability is most acute among independent, non-hospital-affiliated centers, which lack the institutional capital necessary to mitigate operational disruptions. Furthermore, these closures are disproportionately concentrated in regions characterized by lower median incomes and higher rates of uninsured populations.

發表在《國際放射腫瘤、生物學與物理學期刊》的一項分析顯示，2018 年至 2025 年間，放射治療的獲取渠道出現了系統性減少。數據指出，超過 5,000 萬名公民居住在完全沒有放射腫瘤科診所的縣。城市與鄉村環境之間存在嚴重差異；城市中心通常保有冗餘的治療選擇，但在鄉村縣，單一設施的關閉往往會導致當地服務完全消失。這種脆弱性在獨立且非醫院附屬的中心最為顯著，因為它們缺乏足以緩解營運中斷的機構資金。此外，這些關閉情況不成比例地集中在收入中位數較低且無保險人口比例較高的地區。

Concurrent with these trends, the Centers for Medicare & Medicaid Services (CMS) has proposed a 2027 outpatient payment rule to implement 'site-neutral' payments for specific imaging services, such as X-rays, CT, and MRI scans. This policy seeks to eliminate the payment premium currently afforded to hospital-owned outpatient departments, aligning their reimbursement with the physician fee schedule. While CMS projects a reduction in Medicare spending by approximately $260 million and a decrease in beneficiary cost-sharing by $70 million, the measure has encountered institutional opposition. Critics argue that such reductions may exacerbate the financial instability of hospitals, particularly those in vulnerable regions, potentially precipitating further service contractions.

與這些趨勢同步，醫療保險和醫療補助服務中心 (CMS) 擬定了 2027 年門診支付規則，針對特定影像服務（如 X 光、CT 和 MRI 掃描）實施「機構中立」支付。此政策旨在取消目前賦予醫院所有門診部門的支付溢價，將其報銷標準與醫師收費表對齊。儘管 CMS 預計 Medicare 支出將減少約 2.6 億美元，且受益人分攤成本將降低 7,000 萬美元，但該措施遭遇了機構對抗。批評者認為，此類削減可能會加劇醫院（尤其是脆弱地區醫院）的財務不穩定，潛在地促使服務進一步縮減。

Institutional stakeholders have highlighted a temporal convergence of these pressures. Dr. Vivek S. Kavadi of ASTRO noted that the observed decline in access preceded the 2026 Medicare reimbursement reductions, suggesting a pre-existing fragility in the provider network. To counteract this erosion, proponents have suggested legislative interventions, such as the bipartisan Radiation Oncology Case Rate (ROCR) Act, to establish a more predictable financial framework for providers.

機構利益相關者強調了這些壓力在時間上的趨同性。ASTRO 的 Vivek S. Kavadi 博士指出，觀察到的獲取渠道下降早於 2026 年 Medicare 報銷削減之前就已發生，顯示供應商網絡預先存在脆弱性。為了對抗這種侵蝕，支持者建議採取立法干預，例如跨黨派的《放射腫瘤科個案率 (ROCR) 法案》，以為供應商建立一個更可預測的財務框架。

The United States faces a dual challenge of declining rural cancer care access and a transition toward site-neutral reimbursement models that may further impact provider viability.

美國面臨雙重挑戰：鄉村癌症治療獲取渠道減少，以及向機構中立報銷模式過渡，而後者可能會進一步影響供應商的生存能力。