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Introduction

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Cancer is a leading cause of morbidity and mortality in North America. In 2012, approximately 186 400 new cases of cancer and 75 700 cancer deaths were expected in Canada,1 and 1 638 910 new cases of cancer and 577 190 cancer deaths were expected in the United States.2 Despite significant differences in the organization and funding of healthcare delivery in the two countries, concerns regarding quality of care exist around issues such as access and medication errors in medicine in general,3-5 and in cancer specifically,6,7 coupled with rapidly escalating healthcare costs.8-10 These concerns have led to substantial interest over the last decade in reforming healthcare delivery at the policy as well as the clinic level in both countries, with significant changes expected in the near future.

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There are significant differences in how cancer services are delivered and paid for in the two countries. In Canada, most health services, including cancer care, are paid for publicly with legal residents of Canada being entitled to receive medically necessary services without co-payment. Each of Canada's ten provinces and three territories is responsible for the organization of health services delivered within their jurisdiction. When it comes to cancer care specifically, most Canadian provinces have elected to develop provincial agencies such as Cancer Care Ontario11 or the British Columbia Cancer Agency12 to organize and deliver cancer services. As a result, most Canadian provinces have a centralized approach to cancer services delivery, with networks of regional cancer centres and various affiliated institutions providing the vast majority of specialized services such as radiation and chemotherapy. In the USA, by contrast, a number of systems exist for paying for health services, including cancer care. These are composed of public programmes, such as Medicare (for individuals older than 65), Medicaid (for low-income families and individuals) and the Veterans Affairs Health Care System (for veterans), in addition to a wide variety of private insurance plans usually obtained as part of an employment package. There is also a substantial proportion of Americans younger than 65 who are uninsured; however, with the passage of the Patient Protection and Affordable Care Act in 2010, most Americans are expected to have access to health insurance either through publicly funded programmes, employer-sponsored plans, or by purchasing individual coverage through health insurance exchanges. Given the heterogeneous financing of healthcare in the US, most cancer care is delivered through a fee for service model, with the majority of cancer patients receiving care in community-based settings by private practitioners. Whilst this may provide patients with many providers to choose from, it can also result in care that is delivered across multiple settings and is often fragmented.

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One of the biggest challenges facing cancer care delivery in both Canada and the US is the management of acute problems, such as treatment of adverse events, or complications relating to the cancer itself, especially in patients with ...

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