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Cancer Financial Toxicity in India
Context:
Financial toxicity is the most devastating yet least assessed form of cancer toxicity, impacting not only the patient but their families, sometimes trapping them in a cycle of generational poverty.
What is Financial Toxicity?
- Financial toxicity describes the problems patients encounter related to the cost of medical care.
- These out-of-pocket expenses include copayments, deductibles, and coinsurance, which are costs not covered by health insurance.
- Cancer treatments, such as surgery, radiation therapy, and systemic treatments, can be extremely expensive, often leading to high out-of-pocket expenses.
The Burden of Cancer Costs
- High Costs of Diagnostics and Treatment: Advanced diagnostic tests like a 12-gene next-generation DNA sequencing panel can be life-saving but remain unaffordable for many.
- Expensive Treatment Options: Targeted therapies, immunotherapy, monoclonal antibodies, and proton therapy are crucial breakthroughs but largely inaccessible to low- and middle-income groups.
- Case Studies:
- Vijay, a low-income lung cancer patient, couldn’t afford a crucial test that could guide treatment.
- Aslam, a 70-year-old oral cancer patient, has already spent ₹25 lakh over five years, forcing his family to sell assets.
Financial Toxicity of Cancer
- Impact Beyond the Patient: Families often sell property, exhaust savings, and even skip meals to afford treatment.
- Generational Poverty: The financial strain can push families into long-term economic, social, and nutritional poverty.
- Direct vs. Non-Medical Costs:
- Medical costs: Diagnostics, medicines, hospitalisation.
- Non-medical costs: Travel, lodging, food.
- Example: Afreen, a cancer patient, spent ₹400 out of ₹500 on travel and medicines, leaving just ₹100 for survival.
Gaps in Public and Private Healthcare
- Insurance Limitations: Schemes like Ayushman Bharat cover only inpatient costs. Outpatient expenses (diagnostics, post-discharge care, follow-ups) require out-of-pocket (OOP) spending.
- Public Healthcare Shortcomings: India’s public health spending remains below 2% of GDP. Public hospitals face staff shortages, limited facilities, and long wait times for diagnostic tests and surgeries.
- Rise of Private Healthcare: India’s hospital market is valued at ₹8 lakh crore, growing at 8% CAGR. Private sector growth raises concerns about increasing financial toxicity.
Efforts to Address Financial Toxicity
- State-Level Initiatives: Delhi, Maharashtra, Punjab, and Kerala have introduced schemes to finance medical costs.
- Indian Railways and Air India offer discounted fares for cancer patients.
- Himachal Pradesh and Haryana provide free bus travel for patients.
- Nonprofit and NGO Contributions: The National Cancer Grid has reduced the cost of 40 high-value cancer drugs by 82% through pooled procurement. The Cachar Cancer Hospital in Assam provides holistic support, including accommodation, meals, and temporary employment for caregivers.
Role of Philanthropy and CSR
- Need for Strategic Investments: Increased government funding and strong political will are crucial.
- Nonprofit Sector Impact: India has 3 lakh nonprofits registered on the Darpan portal (NITI Aayog), with 85,000 focused on health. Only a fraction specialise in cancer care.
- Funding Sources:
- CSR Contributions: Under India’s CSR Act (2014), companies allocate funds for social causes.
- ₹6,800 crore CSR funding was directed to healthcare in 2022–23.
- Individual Philanthropy: Despite India’s 100 richest individuals having a combined wealth of ₹8.4 lakh crore (Forbes 2024), individual donations remain below potential.
The Future of Cancer Care Financing
- Rising Cancer Burden: Pollution, urbanization, and lifestyle changes are set to increase cancer rates.
- Call to Action:
- Strengthen public healthcare investment.
- Scale up grassroots nonprofit initiatives.
- Enhance philanthropic contributions and CSR funding.
- Implement data-driven policies to reduce financial toxicity.
A multi-pronged approach involving government policies, nonprofit interventions, and private sector contributions is essential to ensure equitable cancer care in India.
