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Lancet Oncol. 2014 May;15(6):e223-33. doi: 10.1016/S1470-2045(14)70117-2. Epub 2014 Apr 11.

Delivery of affordable and equitable cancer care in India.

Author information

1
Tata Memorial Centre, Mumbai, India. Electronic address: prameshcs@tmc.gov.in.
2
Tata Memorial Centre, Mumbai, India.
3
Dr B Borooah Cancer Institute, Guwahati, India.
4
Kamala Nehru Memorial Hospital, Allahabad, India.
5
Cancer Institute Adyar, Chennai, India.
6
MNJ Institute of Oncology, Hyderabad, India.
7
Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
8
Army Hospital (Research and Referral), Delhi, India.
9
Birla Cancer Center, SMS Medical College Hospital, Jaipur, India.
10
Regional Cancer Centre, Cuttack, India.
11
All India Institute of Medical Sciences, Delhi, India.
12
Regional Cancer Centre, Thiruvananthapuram, India.
13
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
14
Gujarat Cancer and Research Institute, Ahmedabad, India.
15
Kidwai Memorial, Bangalore, India.
16
Amrita Institute of Medical Sciences, Kochi, Kerala, India.
17
Guy's and St Thomas' Hospital, Institute of Cancer Policy, King's College London, London, UK.
18
King's Health Partners Cancer Centre, King's College London, London, UK.

Abstract

The delivery of affordable and equitable cancer care is one of India's greatest public health challenges. Public expenditure on cancer in India remains below US$10 per person (compared with more than US$100 per person in high-income countries), and overall public expenditure on health care is still only slightly above 1% of gross domestic product. Out-of-pocket payments, which account for more than three-quarters of cancer expenditures in India, are one of the greatest threats to patients and families, and a cancer diagnosis is increasingly responsible for catastrophic expenditures that negatively affect not only the patient but also the welfare and education of several generations of their family. We explore the complex nature of cancer care systems across India, from state to government levels, and address the crucial issues of infrastructure, manpower shortages, and the pressing need to develop cross-state solutions to prevention and early detection of cancer, in addition to governance of the largely unregulated private sector and the cost of new technologies and drugs. We discuss the role of public insurance schemes, the need to develop new political mandates and authority to set priorities, the necessity to greatly improve the quality of care, and the drive to understand and deliver cost-effective cancer care programmes.

PMID:
24731888
DOI:
10.1016/S1470-2045(14)70117-2
[Indexed for MEDLINE]

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