Cancer Economics – Why we need decentralization of cancer care.

Author: Dr Sujeet Kumar @sujeethemat

Before I dive into the economics part, I would like to tell you a incidence which forced me to think, calculate and write this piece.

This patient (multiple myeloma) lives 600 km away from the hospital and as many patients with myeloma are initially at least partially wheel chair bound, it is quite difficult to mobilize him. The real struggle and expense of taking this patient to a hospital 600 km far away, arranging a overnight stay in a different city and taking him back to home is beyond imagination of a doctor sitting in his OPD or a bureaucrat involved in health scheme planning or a politician eager to announce the benefits of health schemes. You only know when you have to go through this.

The patients son told me the breakup of his expense’s from booking a private vehicle to nearest railway station (as he is wheel chair bound – no, not for luxury or comfort), reaching hospital from railway station, lodging and fooding expenses for 2 persons in a city and again back to home on a booked private vehicle from nearest railway station. All went up to near 3000 INR mark. All this in spite of the  free/subsidized railway ticket provided by govt for cancer patients and their attendants.

This led me to analyze monthly cost of some commonly used chemotherapy protocols in myeloma – a calculation that I had never done before in spite of writing them reflexively on prescription diary in last 4 years. Below is the table of chemotherapy expenditure of two commonly used chemotherapy regimens in myeloma in India.

So many patients who come from far have to spend at least 1 rupee to avail benefit of 2 rupee and patient need to arrange this 1 rupee beforehand. Only those who can arrange 1 rupee can avail health benefit worth 2 rupee and in country like ours, not all can do that.

The govt aid in cancer treatment has helped majority of these patients to bear the cost of cancer chemotherapy and by rough estimate around 40-50% of patients visiting a govt hospital for cancer treatment do receive some sort of financial assistance from govt schemes. This assistance takes care of chemotherapy and investigation costs. In case these health schemes were not in place, the drop out rates would have been staggering. Hence I say that first step is complete “patient at least thinks about coming to hospital”.

The above scenario is just an example and there the more complex unheard stories about patients not being able to take chemotherapy or cancer treatment even if it is being provided free. The solution to this problem is “let the hospital reach to patient”. But it is not as simple as writing this piece.

Govt has been trying to push manpower and infrastructure to periphery. This “push to periphery” approach has already been tried by different state govts and has received mixed response. The shift in approach from “push to periphery” to “draw to periphery” is needed. How to do it is altogether a different topic of discussion and it is not that health planners in India don’t know how to do it.

With an optimistic mind I hope that some day we will have a decentralized health care facility. Needles to say that general health care facilities needs to be decentralized first and then only we can think of satellite cancer care facilities. Hope health care planners just don’t focus on raising and inaugurating buildings and actually work towards drawing health care workers to periphery – the “draw to periphery” approach.

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