Cancer care in India, especially for the lower and middle classes, can turn out to be a nightmare. While treatment protocols, and consequent costs vary across a broad range, depending upon the site of cancer and the stage at which it is detected, oncologists attest that it can be a huge drain on the resources of a family.
With heavy out-of-pocket health expenditures being chronicled reliably at the national level, and a relatively low percentage of the population going in for health insurance, much of the money spent should come from the people themselves. The Commission on Macroeconomic and Health Financing of Health in India in its report noted that it is disquieting nearly 70 per cent of the total health expenditure in India comes from households, while around 25 per cent is financed by the Central, State and local governments.
Though elaborate costing studies to specifically calculate direct and indirect expenses of cancer are not available in the public domain, it is through a process of deduction (from out-of-pocket expenses), and evidence that is, by and large, empirical and anecdotal that doctors use to comment about costs involved in cancer care.
One study, conducted by the All India Institute of Medical Sciences (AIIMS) that commenced in 2006-2007 (reproduced by Bidhu Kalyan Mohanti et al in the October 2011 issue of the Economic and Political Weekly) aimed at estimating the costs of treatment borne by cancer patients at a tertiary care setting.
The study, as the authors stated in the article, was to “capture the costs borne by Indian cancer patients and family during the course of radiotherapy.” The study was conducted along with the Indian Statistical Institute. “We find that the average cost across all treatments is Rs.1,602 per week.” Patients end up paying around Rs.8184 for a seven-week course in radiotherapy, as much as 59 per cent of this is spent on transportation and food and lodging. The treatment plan with the radiotherapy alone is cheapest, they add.
The average economic burden to a patient being treated at AIIMS amounted to Rs.14,031 (before start of radiotherapy), add to that Rs.8,184 totalling up to Rs.22,215.
If the average expenditure of Rs.14, 597 made before coming to AIIMs is added, an average cancer patient surveyed in the study would have to bear an economic burden of Rs.36,812 for the entire cancer therapy course.
Anyone who requires other forms of treatment including surgery and chemotherapy, obviously will have to pay more. “Most often, depending on their type and stage of cancer, patients will require more than one form of treatment,” explains V. Shanta, chairperson, Adyar Cancer Institute.
For the poor, no doubt, cancer care is unaffordable, she adds, while, varying rates of treatment in the private sector may make it within the stretched means of anyone in the middle class.
Modern technology today has led to wonderful cures, Dr. Shanta adds. Since technology costs good money, the costs of diagnosis, and thereon, treatment, have consequently burgeoned. Even the simplest radiotherapy unit costs several crores of rupees and in addition annual maintenance costs are high.
Priya Ramachandran, founder, Ray of Light Foundation which supports treatment for children with cancer, says while drugs for chemotherapy itself may not cost much, supportive third generation antibiotics can hollow out a family's savings. In case of children with leukemia, where complications occur from opportunistic infections contracted during the period when immunity is lowest, there is no estimating the costs that could add up for treatment.
“In the case of one young boy we eventually lost, we spent nearly Rs.7 lakh for a period of one and a half years. Without the complications he developed that required him to be in the intensive care unit, it might have just cost Rs.1 – 1.50 lakh for the same period,” Dr. Priya explains. But invariably, some complication does arise out of severe immuno suppression that is part of the treatment.
While insurance companies do not find it ‘practical' to underwrite new patients who have already been detected with cancer, health insurance remains the strongest support mechanism for people battling the disease.
“On an average, the costs can be between Rs.80,000 and Rs.1,00,000 per annum. But there are people who can run up several lakhs of rupees depending on the treatment they are put through,” explains S. Prakash, executive director, Star Heath and Allied Insurance.
“We have seen several middle class families being completely destroyed, just paying for cancer treatment. They have to sell off property and borrow heavily to keep treatment going. By the time they are ready to go home, they would be deep in debt and without any assets,” Dr. Prakash explains.
Sufficient awareness on the importance of subscribing for medical insurance must be propagated, he recommends. Philanthropists can also look at subsidising the premium costs of a community or group of people who may not be able to afford the annual expense, according to him.
As per the revised Chief Minister's Comprehensive Insurance Scheme, costs for diagnosis will also be borne by the State even if the result does not indicate a malignancy.
Under the previous scheme, only in case of a malignancy result is declared, would the procedure be covered.
At the national level, in 2009, the Health Minister's Cancer Patient Fund was created within the Rashtriya Arogya Nidhi Scheme. It proposed to establish the revolving fund in the Regional Cancer Centres (RCC) to speed up financial assistance to needy patients. A sum of up to Rs.1 lakh would be provided as assistance to cancer patients in the BPL category.
According to the National Cancer Control Programme website, initially, 27 RCCs have been proposed, for whom funds amounting to Rs.10 lakh have been released.
