Reducing cancer treatment burden in the Northeast

The alarming rise in cancer cases in the Northeast region dominates the public discourse, and the awareness campaigns are more visible now, which raises hope for early screening and lifestyle modifications that are crucial for cancer prevention. However, the high cost and burden of treatment in the region due to poor access to affordable treatment continues to be the elephant in the room. The Parliamentary Standing on Petitions has flagged a number of gaps in cancer care, addressing which is deeply relevant to reducing the burden of households with cancer patients in the region. The Committee found that over 70% of cancer cases in India are diagnosed at advanced stages of III and IV, requiring intensive and costly interventions. It’s observation that early detection, therefore, remains the most critical factor in reducing cost brings home hard realities for the households with cancer patients in Northeastern states, as the number of non-communicable disease clinics under them is disproportionately low in the region. This calls for reallocation of budgetary resources for healthcare, particularly in the region, to improve cancer screening through the establishment of well-equipped NCD clinics in all districts, including rural areas, to provide accessible screening facilities, as recommended by the parliamentary panel. A comprehensive review of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS), under which screening centres are funded, has become an urgent necessity to identify the reason why it failed to achieve the objectives. Besides, there are critical gaps in insurance coverage that add to the treatment burden. The Committee’s report quantifies the gaps which deserve the attention of policymakers and the Insurance Regulatory and Development Authority (IRDAI). In terms of insurance coverage, approximately 70-80% of cancer-related expenses in India are met through out-of-pocket payments. The average cost of cancer treatment per patient is estimated to be around Rs. 7.5 lakhs, which is unaffordable for most families. Insurance penetration remains inadequate, with 52% of policyholders being underinsured and 27% having coverage below ?5 lakhs. Moreover, claim rejection rates remain high at nearly 19%, further limiting the utility of existing insurance schemes. Further, there is low awareness about medical insurance, especially amongst the rural population, the report highlights. The Ministry of Health and Family Welfare attributes the high cost associated with cancer treatment to the requirement of surgery, chemotherapy, radiation, targeted therapy and immunotherapy, each of which has a high cost. It explains why affordability of cancer care remains a challenge for economically weaker sections of the society. The Committee’s recommendation that the price caps enforced by the National Pharmaceutical Pricing Authority (NPPA)—such as the existing 30% trade margin cap on 42 essential anti-cancer drugs—be extended to cover cancer vaccines, immunotherapy, and oral chemotherapy deserves urgent and serious consideration by the government to end the disparity in access to cancer care. Another factor contributing to higher costs for cancer patients in the region, more particularly from rural areas, is the shortage of oncologists requiring them to travel to Delhi and other metro cities, which increases their out-of-pocket expenses. The parliamentary committee found that most medical professionals prefer to work in urban areas, in the private sector or overseas, as the remuneration is attractive. It also highlighted a striking paradox that while the number of medical colleges and medical seats has increased, a considerable number of medical professionals are opting to work abroad. “Many of these individuals have benefited—either directly or indirectly—from public funding through grants, scholarships, or subsidised education while studying in Indian institutions. In light of such a high rate of exodus, the increased availability of medical seats is not resulting in a proportional increase in medical professionals serving within the country,” states the report, which suggests that a mere increase in the number of medical colleges without an effective retention strategy cannot close the critical gap in equitable access to medical care. An effective step to improve cancer care in the region with high incidence but with the majority of affected households belonging to economically vulnerable sections can be the implementation of the committee’s recommendation that more cancer hospitals equipped with advanced medical technology be established through government funding, private sector participation, and public-private partnership models and empanelling those within insurer networks to enable the provision of cashless services to patients. Establishment of cancer hospitals in PPP models can offset the high cost of radiodiagnostic equipment like CT scans, MRIs, PET scans, and molecular diagnostics, which are passed on to the patients. It points out that most cancer care equipment and devices are imported, and the resultant high import duties, coupled with indirect taxes, add to treatment costs, which need policy rethinking so that the benefits of modern equipment also become affordable for patients. Increasing budgetary support for cancer care to moderate the diagnostic and treatment cost is critical to reducing overall cancer burden in the region.