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Affordability in cancer care

One of the latest reports of the Parliamentary Standing Committee on Health and Family Welfare has revealed that India lacks adequate information about the incidence and type of cancer even after four decades of implementation of the National Cancer Registry Programme


Sentinel Digital DeskBy : Sentinel Digital Desk

  |  8 Oct 2022 3:17 AM GMT

One of the latest reports of the Parliamentary Standing Committee on Health and Family Welfare has revealed that India lacks adequate information about the incidence and type of cancer even after four decades of implementation of the National Cancer Registry Programme. The current Population Based Cancer Registry (PBCR) covers approximately 10% of the population, of which rural population coverage is only one per cent. This is certainly a critical gap highlighted in the report that needs to be bridged at the earliest. A key policy recommendation made by the parliamentary panel is classifying cancer as a notifiable disease to facilitate accurate information on cancer burden on which the Central and the state governments will have to take the call. Policy makers paying equal attention to affordability of cancer care is critical in cancer prevention and management. Since 2008, the Indian Council of Medical Research has been recommending to the Central government to make cancer a notifiable disease, but the persistent position of the Ministry of Health has been that it is done only in respect of contagious diseases and replicating it for cancer will increase unnecessary burden of paperwork. The argument advanced by the government to back its position is that strengthening PBCR and Hospital-based Cancer Registry can facilitate quality data on cancer burden. The parliamentary committee, however, notes that many areas remain under-represented in the existing cancer registries and recommends to the Ministry to take measures to expand the scope of PBCR and ensure conducting more rural-based PBCRs to get accurate information about the incidence and types of cancer across the country. The committee strongly believes that making cancer a "Notified Disease" will ensure a robust database of the cancer deaths and also help in determining the accurate incidence and prevalence of cancer in the country, besides analysing the risk factors, implementing screening programmes and allocating proper resources to improve cancer outcomes. The committee has flagged the issue of low trust and inadequate public cancer care services leading to most people with cancer first approaching private sector as one of the key challenges in cancer prevention. It underscores the need for upgrading existing cancer care facilities and expand those to the areas which have high incidence of cancer cases, especially in the North-eastern region so that the patients get access to quality and cost-effective cancer care. The committee rightly insists that a strong network of cancer care centres across the country would facilitate early diagnosis of cancer cases and greatly reduce the burden of cancer cases in India. The report highlights that the high cost of cancer healthcare often leads to a substantial financial burden on the patient and their family. "One third of households with individuals with cancer are estimated to spend more than half of their per capita annual household expenditure on hospitalizations," it states and further adds that the out-of-pocket spending for cancer care in private facilities is about three times that of public facilities. About 40% of cancer hospitalization cases are financed mainly through borrowings, sale of assets and contributions from friends and relatives. To overcome the problem of high charge for cancer treatment in private hospitals, the committee suggestion that more government hospitals should be established across the country for providing affordable cancer treatment. This will require the Central and state governments to significantly increase allocation in the Budget for cancer care. The committee endorses the views of the Department of Atomic Energy that existing government hospitals should be upgraded to create oncology departments and these departments should also have "private patients" who pay for their care, and partially subsidize the "free" patients who are not charged. It also recommends earmarking 25% reservation on cancer services in private hospitals for patients treated on government schemes. If these recommendations are implemented, it will provide relief to many patients belonging to low-income and marginalized households. Another key policy intervention by the government, which the committee has recommended, is reducing the Goods and Services Tax (GST) on cancer medicines and exempting those from custom duties to bring down the prices. The panel points out that as compared to other Asian countries, import duties on cancer medicines in India are very high. Although the basic import duties for pharmaceutical products average about 10%, but as a result of the integrated GST (5-12%) imposed on imports, the effective import duty often exceeds 20%. Furthermore, excessive duties on the reagents and equipment imported for use in research, development and manufacturing of biotech products make the cost of manufacturing cancer drugs too high. The Central government accepting the committee's recommendation that drugs and vaccines used in the prevention and treatment of cancer should carry minimum GST and should be exempted from customs duties will be crucial in increasing affordability of cancer treatment.

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