On March 14, the Minister of State for Health said cancer cases in India will cross the 15 lakh mark by 2025. A research paper published by the Indian Council of Medical Research in December last year estimated that cancer cases are likely to increase from 14.6 lakh in 2022 to 15.7 lakh in 2025 in India. In the last decade, cancer cases have risen from around 10 lakh in 2012 to 14.6 lakh in 2022 (Chart 1).
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While increasing disease burden is a concern, the economic burden is equally a worry given that cancer treatment is among the most expensive compared to other diseases. A Parliamentary Standing Committee report on cancer, released in September 2022, expressed concern about the “inaccessible and increasing cost of cancer treatment.” For instance, according to the National Sample Survey (NSS) 2017-18 report, the average medical expenditure per hospitalisation case for cancer treatment was Rs. 68,259 in urban areas (Chart 2). The average expenditure for cardiovascular disease, the second-most expensive disease on the list, was Rs. 47,788. The Committee said that while anti-cancer medicine costs can be regulated, the cost of treatment also depends on other expenditures such as radiotherapy. Radiotherapy machines are not manufactured in India and are therefore expensive. It said that the cost of radiotherapy cannot be regulated as it has not been declared an essential service.
Notably, a significant share of medical costs is incurred by patients in India due to relatively poor insurance penetration. According to the NSS 2017-18 report, more than 80% of hospital bills are paid out of pocket. Chart 3 shows the average medical expenditure and average out-of-pocket expenditure per hospitalisation case as per the NSS report.
While comparison data post the implementation of Ayushman Bharat, an insurance scheme launched in 2018, are not yet available, the Committee observed that doctors’ “entire prescription and latest cancer therapies were not covered in the scheme.” It also said that many diagnostic tests are not covered. And given that initial investigations can be “very expensive, it leads to delay in treatment.”
The Committee observed that some State-specific insurance schemes have been highly beneficial to the community at large, and suggested a convergence of State and Central schemes. Its observations are accurate as the cost of cancer treatment does vary widely across States. Chart 4 shows the State-wise average medical expenditure incurred per hospitalisation case for cancer treatment in government hospitals as per NSS 2017-18. The chart shows that expenditure was lowest in Tamil Nadu and Telangana (with less than Rs. 1,000 spent per case) followed closely by Andhra Pradesh. This is an outcome of existing State-specific insurance schemes. While expenditure was highest in the northern and northeastern parts of India, the central, eastern, and western States were middling.
The NSS data also show that 153 per 1 lakh people in the 45-59 age group and 300 per 1 lakh in the 60-69 age group reported hospitalisation due to cancer (Chart 5). This shows that cancer often strikes around the retirement age of an earning member, which leads to a mounting debt burden.
The data also show that the average hospital stay of 14.1% of cancer patients was more than 30 days in India, while on average, only 2.3% of patients stay in the hospital for that long (Chart 6). As longer stays lead to higher bills, cancer is indeed an expensive disease to treat.
Thanmaya Prakash is an intern at The Hindu
Source: Indian Journal of Medical Research, NSS 2017-18, Rajya Sabha and Lok Sabha questions
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