GS Paper II

News Excerpt:

A person with cancer pays for medical care as well as bears the cost of accessing and sustaining that care.

Present Scenario of Cancer in India:

• The estimated number of incident cases of cancer in India for the year 2022 was found to be 14,61,427 (crude rate:100.4 per 100,000). In India, one in nine people is likely to develop cancer in his/her lifetime.
• By 2040, according to one estimate, 20 lakh people a year will be diagnosed with cancer in India. Cancer is already the third leading cause of death in India. In the coming years, it is also expected to take over heart disease and infections.

Magnitude of the Problem/Challenges for the Indian Health Care System:

• Unavailability of timely and effective treatment: Patients in India face double-sided loss during their treatment- direct and indirect OOPE.
  • Direct medical OOPE (out-of-pocket expenditure) includes doctor’s consultation fees, cost of medicines, and medical tests, and direct non-medical OOPE includes costs of transport, accommodation, and food for people travelling to larger cities for treatment.
  • Indirect OOPE accounts for the loss of productive hours and/or income. For example, The blood investigations here take at least 10 days to be reported.
    • • Ideally, one’s OOPE for health should be zero. However, the sheer burden of disease plus an underfunded public health system forces people to access care in India's private healthcare system.

• High cost for treatment: Although the Pradhan Mantri Jan Arogya Yojana (PMJAY) has offered some respite by providing health insurance of Rs 5 lakh per family per year, a study conducted in 2023 reported that even among patients with PMJAY or other state-sponsored health insurance coverage, cancer treatment rendered catastrophic health expenses in more than 80% and impoverishment in more than 60% of people.

• Unrepresented and rising demand of the Population: Population-based cancer registries within the National Cancer Registry Programme and outside the network have provided a picture of the cancer pattern in India. (shown in map)
• Some areas are primarily unrepresented, but the general pattern seems good. 
• Based on the cancer registry data, it is estimated that there will be about 800,000 new cancer cases in India every year. At any given point, there will likely be 3 times this load, about 240,000 patients.
• Accuracy issue of India’s cancer registries: India is expected to shoulder a sizeable cancer burden by 2030, but its official cancer registries don’t reflect reality due to a lack of funding and low awareness. 
• The registries function as the data storage backbone for a nationwide cancer surveillance programme, recording information about what types of cancers occur and where a region’s demography makes some cancers more common. 
• However, these registries are incomplete, covering only about 16% of India’s 140 crore population. Financial resources are concentrated mainly in urban regions, and the data collected is often delayed and inaccurate. 

Government Initiatives:

• Arogya Kosh scheme: In 2017, Delhi launched the Arogya Kosh scheme to reduce the burden on public health centres and avoid treatment delays. Here, residents of Delhi making less than Rs 3 lakh a year are eligible to get specific tests, like ultrasound and CT scans, in private health centres for free. However, 93% of people seeking care in government hospitals in Delhi were unaware of the scheme, reducing the scheme’s uptake.
• Efforts taken by state governments:

• • Haryana: The Haryana government made transport for patients with cancer and one caregiver in public buses from their places of residence to their places of treatment free. 
  • Kerala: Similar efforts have been made in the Kerala government, where patients with cancer are eligible for 50% concession on public bus tickets. 
  • Assam: To improve compliance with care, patients travelling to seek care in Cachar Cancer Hospital and Research Center are given financial support for travel, free accommodation, and food.

• Cancer pension: Haryana, Tripura, and Kerala have floated a ‘cancer pension’ to financially assist patients with advanced-stage cancer: Rs 2,500 per month in Haryana and Rs 1,000 in Tripura and Kerala.

Way Forward:

• Concentrated decentralised care system: The most obvious solution to such post-cancer problems is to open publicly funded cancer care centres in every nook and corner of India. Of course, this sounds unrealistic at this time and will require decades to implement.
• Increase in funding: Until cancer care becomes as accessible as diabetes or hypertension care, we will need to continue to provide financial support to those who are suffering, either directly or indirectly, and their families. Free cancer care alone won’t save our people from poverty and suffering.
• Need for Palliative care: More than 75% of cancers in India present in advanced stages, and Palliative care and pain relief are essential to provide a good quality of life for these patients.
• Set up for Cancer registry network: Evaluation of the programme has to be undertaken with reliable data on the incidence and mortality from cancer. A network of cancer registries has to be set up towards this end.
• Role of International Agencies: The central area in which WHO contributes is Tobacco Control, Palliative Care and Human Resource Development. India could take up these programmes, demonstrate to the world that cancer control is feasible, and become a model for cancer control programmes in low-resource settings.

Mains PYQ

Q. The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC 2022)

Q. Can overuse and free availability of antibiotics without Doctor’s prescription, be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved. (UPSC 2014)