How India treats cancer, at all costs
A new study conducted by the city-based International Institute of Population Sciences (IIPS) has revealed a grim picture on the financial problems faced by cancer patients in the country.
The study revealed that two out of five cancer patients in India have to borrow money and sell assets to cover the cost of hospitalisation which may cause them financial distress, the study revealed.
The study has for the first time analysed the cost of hospitalisation for all diseases, and found that cancer, followed by heart diseases, caused the highest ‘distress financing,’ a term used to define borrowing money or selling assets. The results were published in the scientific journal PLOS one in May.
The researchers studied 42,869 hospitalisation cases across India in 2014, using data from National Sample Survey to arrive at the findings. Lead researcher of the study Anshul Kastor and Sanjay Mohanty, professor at IIPS and the author of the study, said that one of the reasons why distress financing among cancer patients is high is because the treatment is prolonged, compared to other diseases, adding to both the medical and non-medical costs.
“A patient may have to undergo multiple sessions of chemotherapy during the treatment. If patients reside in small towns, they have to travel to another city where the facility exists,” Mohanty said.
The health insurance coverage is also very low in the country. Many insurance companies do not cover cancer in their insurance policy, adding to the cost for the patients.
Mohanty added that the average yearly out-of -pocket expenditure for cancer was ₹57,232, the highest as compared to other diseases.
“The figure could actually be higher, as we did not include the patient’s loss of salary or wages during the treatment period, which are also main contributors to financial strain during cancer care,” said Mohanty.
Doctors are not surprised with the findings. Dr Pankaj Chaturvedi, head of department, head and neck surgery, Tata Memorial Hospital (TMH), Parel, where patients across the country come for treatment, said the tragedy of cancer is that treatment on an average lasts for six months, during which the financial pressures keep mounting.
“As per our rough calculation, 70% of the cost of cancer care is out-of pocket and the main contributors are loss of wages, travel expenses, costs of food and lodging and in some cases loss of job,” he said.
At TMH, two-thirds of the 60,000 new patients registered at the centre annually are from outside Mumbai. These patients move to the city to receive quality treatment at an affordable cost, but the cost of living in Mumbai often pushes them into medical poverty, doctors added.
Dr Sudeep Gupta, professor of medical oncology, TMH, said cancer treatment is expensive and that diagnosis at an advanced stage inevitably means that the cost of care will rise substantially. About, 60% of all cancers in India are diagnosed at an advanced stage, he added.
“It is the poor and the lower middle class patients who are at highest financial risks. Many are not covered under any government or private insurance policies,” said Dr Gupta.
A December 2017 report by Federation of Indian Chambers of Commerce & Industry (FICCI) and KPMG had found that only 27% of Indians have health insurance coverage.
Heath experts say there is a need to scale up facilities in government sector which can match up to the quality provided in the private sector. Dr Vinay Deshmane, cancer surgeon at PD Hinduja Hospital, Mahim, said patients prefer private sector over public hospitals for ‘quality treatment,’ even if the cost is beyond their financial reach.
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