With the surge in the demographic and epidemiological transition in today’s era, cancer is considered the emerging significant public health concern in India. The cancer development among individuals affects the individual’s body and mind and disrupts the financial aid of the individuals and their families. The etiology of cancer and its epidemiology have received significant attention from researchers and policymakers1. Cancer is considered the second leading cause of death across the globe and has accounted for 13% of total death rates2. The prevalence of cancer proved to be evident within developed nations but also increased significantly in developing countries.
The Global Burden of Disease (G.B.D.) has recommended that approximately 70% of all cancer deaths have been predominantly found within low and middle-income countries (Dinshaw et al., 2005). Therefore, cancer and research treatment have been known to be one of the most challenging domains within the biomedical sciences and oncologists that are still struggling for ensuring greater survival chances in most cancer patients. Approximately 60% of the mortality rates due to cancer can be prevented with improved preventive and screening facilities3. Most of the cases of cancer survival are concerned with the early cancer diagnosis, easy access to state-of-the-art medical technology considered a prominent policy concern for low-and middle-income countries. The issue increases for developing countries such as India due to its poor geographical coverage of medical services and very little financial protection in health.
More than 75% of cancer care costs in India are paid out of pocket. There is very little insight regarding the complexities and structural issues while emerging economies in Indian states deal with affordable cancer care and control systems. Hence, the need for reasonable cancer care in India requires a proper understanding of significant differences in health spending across individual states and union territories and the gaps in fundamental health indicators and outcomes. General health insurance and even the most comprehensive plans cannot provide individuals full treatment benefits for cancer. Hence, there is a need for acquiring critical illness cover for the same.
Rising healthcare cost in India:
The reports have revealed that almost less than 20% of the individuals in India are covered under health insurance. Approximately 80% of the Indians are still not assured regarding the benefits of the health insurance and other beneficial schemes provided from the Government’s end. The report of the World Health Organisation (WHO), approximately 10 lakh new cases are reported in India every year. The annual death rates of the individuals due to cancer in India is estimated at nearly five lakhs individuals, and WHO predicted the number to rise drastically up to seven lakhs in the year 2015. The incidence showed an immediate five-fold surge by 2025, and the prevalence of the same is increasing to 19% among men and 23% among women by the year 2020. Only 7.1% risk of cancer deaths is estimated before the age of 75 years as per the reports of Globocan 2012, an international cancer research project; insurers claim that one in five cancer claims is by those between 36 and 45 years of age. It reveals that the disease has disrupted the family’s finances due to the loss of income source.
Cancer care is a long-term effect on an individual’s finances, which most often translates into a recurring expenditure. It leads to a substantial financial burden on the family, buying health insurance. Almost 70% of the cancer cases in India are detected at the advanced stages. Hence, the direct approach of the patient with their oncologists while reaching the advanced stage of the disease results in increasing the cost in the treatment and survival to be less likely. The average price of the cancer treatment under a private practitioner usually involves the cost reaching up to Rs 5-6 lakhs, including investigations, surgery and radiotherapy. However, when opting for the targeted therapy, six cycles of chemotherapy cost up to approximately Rs 20 lakhs. These increasing costs of the medical treatment and spiralling cost of treating the significant ailments and surgeries with inappropriate and no availability of health cover results in the financial and mental status of the individuals. Hence, there is a need for adhering to the insurance policy and schemes, which reduces the financial burden during cancer treatment.
Indian Government schemes for cancer treatment:
Some government schemes for helping the patients in providing financial support to the cancer patients have been discussed below:
1. Health Minister’s Cancer Patient Fund (HMCPF): The government scheme offered by the Ministry of Health & Family Welfare under Rashtriya Arogya Nidhi to provide financial support to the patients belonging to the below the poverty line. It was initially started in the year 2009. The utilization of the Health Minister’s Cancer Patient Fund integrates the establishment of the Revolving Fund as under R.A.N. within 27 Regional Cancer Centres (R.C.C.s). This significant step helps ensure and speed up the financial assistance to the needy cancer patients and helps them fulfil their objectives of HMCPF under R.A.N. This scheme usually provides financial support up to Rs 2 lakhs and Rs 5 lakhs in emergencies to cancer patients, which is processed by Regional Cancer Centres (R.C.C.s). The particular individual cases that require the financial support of more than two lakhs are passed on to the Ministry for processing. The Revolving Funds have been generated in all 27 Regional Cancer Centres (R.C.C.s) and up to Rs. Fifty lakhs will be placed at their disposal. The Revolving Funds will be replenished on fulfilment of conditions regarding submission of utilization certificate and list of beneficiaries. Some of the guidelines for applying for the Health Minister’s Cancer Patient Fund (HMCPF) is discussed below:
- Eligibility for Health Minister’s Cancer Patient Fund (HMCPF) within R.A.N.:
- The fund usually provides financial support to those cancer patients dwelling in regions below the poverty line.
- Financial support is allowed for cancer treatment only within the 27 Regional Cancer Centre(s) (R.C.C.).
- The Central Government, State Government, P.S.U. Employees are not eligible for financial support from HMCPF.
- The grant from HMCPF cannot be utilized where treatment and related medical facilities for cancer treatment are available free of cost.
- Procedure for applying: The application form must be downloaded from the official website. The application form needs to be filled and have authenticated signature by the concerned doctor of treatment and countersigned by the Medical Superintendent of the Government hospital/institute/Regional Cancer Centre. A copy of the income certificate needs to be submitted and a copy of the ration card.
- List of 27 Regional Cancer Centres under the scheme of HMCPF:
- Kamala Nehru Memorial Hospital, Allahabad, Uttar Pradesh
- Chittaranjan National Cancer Institute, Kolkata, West Bengal
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka
- Regional Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu
- Acharya Harihar Regional Cancer, Centre for Cancer Research & Treatment, Cuttack, Orissa
- Regional Cancer Control Society, Shimla, Himachal Pradesh
- Cancer Hospital & Research Centre, Gwalior, Madhya Pradesh
- Indian Rotary Cancer Institute (AIIMS), New Delhi
- R.S.T. Hospital & Research Centre, Nagpur, Maharashtra
- Pt. J.N.M. Medical College, Raipur, Chhatisgarh
- Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh
- Sher-I- Kashmir Institute of Medical Sciences, Soura, Srinagar
- Regional Institute of Medical Sciences, Manipur, Imphal
- Govt. Medical College & Associated Hospital, Bakshi Nagar, Jammu
- Regional Cancer Centre, Thiruvananthapuram, Kerala
- Gujarat Cancer Research Institute, Ahmadabad, Gujarat
- M.N.J. Institute of Oncology, Hyderabad, Andhra Pradesh
- Pondicherry Regional Cancer Society, JIPMER, Pondicherry
- Dr. B.B. Cancer Institute, Guwahati, Assam
- Tata Memorial Hospital, Mumbai, Maharashtra
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar
- Acharya Tulsi Regional Cancer Trust & Research Institute (R.C.C.), Bikaner, Rajashtan
- Regional Cancer Centre, Pt. B.D.Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana
- Civil Hospital, Aizawl, Mizoram
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
- Government Arignar Anna Memorial Cancer Hospital, Kancheepuram, Tamil Nadu
- Cancer Hospital, Tripura, Agartala
2. The Health Minister’s Discretionary Grants (HMDG): It is the type of scheme that provides financial support up to Rs fifty thousand to the poor cancer patients in the conditions where these patients are not able to avail accessible medical facilities at the government hospitals. Only those cancer patients who have an annual income up to Rs.1.25,000 and below are eligible for financial assistance of up to 70% of the total bill.
- Broader aspects of sanctioning HMDG:
- Financial assistance is provided to treat major life-threatening diseases in Government hospitals in specific hospitals enlisted under HMDG. Financial aid is not available for chronic diseases requiring prolonged treatment involving recurring expenditure and for conditions for which free treatment is available under National Health Programmes, i.e. T.B., Leprosy etc.
- The reimbursement of the expenditure already sustained is not allowed.
- The Central and State Government employees are not eligible for grants under rules.
- Individuals with an annual family income of up to Rs.75,000 and below are eligible for financial support from HMDG.
- The financial support upto Rs 20,000 is given to the patients on treatment cost is Rs. 50,000, Rs. 40,000 is provided if the treatment cost is above Rs. 50,000 and up to Rs. 1,00,000 , and Rs 50,000 if the treatment cost is above Rs.1,00,000.
- Procedure for applying: The application form must be downloaded from the official website. The application form needs to be filled and have an authenticated signature by the concerned doctor of treatment and countersigned by the Medical Superintendent of the Government hospital/institute/Regional Cancer Centre. A copy of the income certificate needs to be submitted and a copy of the ration card. An application needs to be forwarded to the Ministry of Health & Family Welfare.
3. The Central Government Health Scheme (CGHS) is applicable for retired Central Government employees and their dependents. In order to provide better cancer treatment facilities to CGHS beneficiaries, one private hospital in Hyderabad and 10 Private hospitals in Delhi were registered in June 2011 under CGHS, mainly for availing Cancer treatment as per the rates of Tata Memorial Hospital for Cancer Surgery. The patients are eligible for availing of the cancer treatment at approved rates within any hospital that constitutes several cancer treatment options.
- Eligibility for Central Government Health Scheme (CGHS):
- The facilities of CGHS are applicable for all those central government employees. They are withdrawing their salary from the Central Civil Estimates and their dependent family members residing in CGHS covered areas.
- The pensioners of the Central Government or the family pensioners who are receiving the pension from central civil estimates are eligible for availing the facilities of CGHS for their cancer treatment.
- Other members eligible for CGHS are the sitting and ex-members of Parliament, Ex-Governors and Lt. Governors, freedom fighters, ex-vice presidents, sitting and retired judges of the Supreme Court, Retired Judge of High Courts, Journalists accredited with PIB (in Delhi), employees and pensioners of certain autonomous or statutory bodies which have been extended.
- The CGHS facilities in Delhi are available to the Delhi Police Personnel in Delhi only, Railway Board employees, Post and Telegraph Department employees.
4. Prime Minister’s National Relief Fund (PMNRF): It mainly aims for providing financial support to the poor patients for the disease treatment at Government/PMNRF designated hospitals to the partial settlement of the expenses. The patients are eligible for the grant of financial assistance through an application addressed to the Prime Minister. Disbursements are integrated at the sole care of the Prime Minister, keeping in view the availability of funds and previous commitments of the PMNRF. It is applicable for the victims of natural disasters and also provides partial coverage for heart surgeries, kidney transplantation, cancer treatment, and more such treatments.
- Procedure for applying: The application form must be downloaded from the official website. The available hospital falling under Prime Minister’s National Relief Fund (PMNRF) needs to be checked under the list. The PMO needs to be submitted along with the two passport-size photographs of the patients, a copy of residence proof, an original medical certificate detailing the condition and estimated expense, income certificate.
5. Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme or Ayushman Bharat Yojana (AB-PMJAY scheme): It is known as the flagship National Health Protection Scheme being funded by the Government of India. It is, also known as Ayushman Bharat Yojana, aims for covering up to 50 crore citizens of India constituting rural and urban regions of the country. It is one of the biggest healthcare schemes being sponsored by the Government of India. Ayushman Bharat Yojana (AB-PMJAY) will help underprivileged families avail the best healthcare services with insurance coverage up to INR 5 lakh for each family per year for tertiary and secondary hospitalization expenses involving diagnostic cost, medical treatment, hospitalization, pre-existing illnesses and several critical ailments. It facilitates cashless healthcare services to its beneficiaries in public sector hospitals and private network hospitals.
- Eligibility for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme for Rural:
- The individuals belonging to scheduled caste and scheduled tribe families are eligible to gain the benefits of this scheme.
- The households with no male members fall under the age group of 16-59.
- The families are dwelling in one room with Kuccha Kuccha walls and roof.
- The household without a healthy adult member and one disabled member
- Manual scavenger families
- Manual labour as the primary source of family income involving landless households earning
- Eligibility for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme for Urban:
- Domestic worker
- Mechanics, electricians, and repair workers
- Sanitation workers, gardeners, and sweepers
- Domestic help
- Home-based artisans and handicraft workers
- Cobblers, hawkers, and people provide services by working on streets or pavements.
- Transport workers such as drivers, conductors, helpers, cart, or rickshaw pullers
- Plumbers, masons, construction workers, porters, welders, painters, and security guards
- Assistants, peons of a small organization, delivery men, shopkeepers and waiters
- How to avail AB-PMJAY:
- The patient approach towards authorized hospitals comes under the scheme of AB-PMJAY constituting the Ayushman Mitra help desk allowing the prospective beneficiary to check through the documents for verifying the documents and the eligibility criteria for enrolling into the plan.
- Beneficiary identification and registration: The confirmation regarding the patient’s beneficiary under PMJAY using software is undertaken, and confirming the identity through Aadhar is done.
- Pre-authorization request and approval: The hospitals are offered for the hospital selection, checks and balance. The submission of the supporting evidence is required for the treatment.
- The treatment protocol is initiated after the identification and authorization.
- The patients are later discharged from the hospital after seeking appropriate treatment.
- Claims request and settlement: The discharge and post-treatment evidence summary must be submitted. The summary may be in the form of electronic payments and beneficiary feedback.
- Procedure for applying: No appropriate procedure for registering into Ayushman Bharat Yojana is available. It is mainly applicable for all the beneficiaries as per SECC 2011 and those already a part of the RSBY plan. The eligibility criteria of beneficiaries for the PMJAY scheme will be checked while following some basic steps.
- The official site of the PMJAY government needs to be visited.
- The individual will fill in the contact information and generate the OTP for the same.
- The individual will select their name and enter the name search by HHD number/ration card number/mobile number.
- Further verification will be done depending on the family’s information being covered under the PMJAY scheme.
6. State Illness Assistance Fund (SIAF): It is mainly integrated for the specific states and union territories for setting up the Illness Assistance Fund offering coverage of up to Rs. 1 Lakh for cancer treatment at government hospitals within the state. Many states do not constitute this scheme, while the other states support the plan.
- Procedure for applying: It will include checking whether the state provides all the criteria for SIAF. The application form needs to be downloaded. The shape needs to be filled and submitted with a BPL card and two photographs at the government hospital.
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