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The latest announcement from the ministry of finance on GST rate cuts has been particularly welcome from a public health point of view. Other analyses notwithstanding, the 5% reduction for several health care related “products”, including pharma and medtech holds considerable promise. Significantly, and importantly, a number of anti-cancer treatments have made the “cut”—some have received a reduction of 12% – 5%, others are at absolute zero. GST on health insurance has also been lowered. But the question remains: How will the benefit be passed on to the consumer?
This comes close on the heels of two important developments in the oncology care universe. First, a significant study published in the latter part of August analysed data from 43 population-based cancer registries and found large regional disparities and a growing cancer burden across the country. Indians have an average lifetime risk of 11% when it comes to developing cancer (in some areas it is nearly double this), well over 1.5 million developed cancer, and more than 0.8 million died of it.
The National Cancer Registry Program (NCRP) covers around 16% of the country’s population, and the estimated incidence is calculated based on weighted or simple averages of the data samples from various registry sites around the country. Since cancer notification is not mandatory, it would be safe to assume that we are missing the complete picture. In fact, an EY report (from 2024) suggested that the figures could be at least 1.5 times to three times the prevailing estimate.
The second positive news is that the Rajya Sabha petitions committee, in its recent 163rd report addressing a petition to make cancer treatment more affordable and more widely available, suggested critical steps to tackle the growing incidence of the disease in the country. In this context, it is reassuring, indeed almost prescient, that these rate cuts have come into effect at this time. This is a welcome starting point in improving affordability and access; but we still have a long way to go.
According to a 2023 study in JAMA Oncology, the global economic cost of cancers from 2020-2050 is estimated to amount to $25.2 trillion. This figure factors in the cost of care in different countries; for India, there is no doubt that cancer care as it stands now will definitely impact the economy. Insurance cover for cancer diagnosis and treatment varies based on different estimates across the country and depending on private and public costs and subsidies. But many affected people still fall between the cracks of insurance coverage. A 2023 paper by Prinja et al estimates that mean out-of-of-pocket expenditure for a cancer patient per OPD visit is ₹8,503 and per hospitalisation is ₹39,085. For many people, this means the difference between life and death.
To address this, we need comprehensive data. This is the only way we can set up awareness measures for early screening and detection where possible and access to the global best in class therapeutics (pharmacological, immunological and targeted therapies). Cancer treatment is expensive and new therapies even more. Hence, we need alternative financing sources and, in parallel, government incentives (and collaboration) for R&D for new molecules/ methods.
Financing is a crucial part of cancer survival rates. Tax exemptions will help, but beyond that we need to create more fiscal space for cancer care. Insurance models need to be reviewed, and the government must reassess its own framework and also ally with/regulate private insurance models for cancer tests and treatment.
In our recent report on exploring alternative financing mechanisms for cancer in India, we reviewed interesting models from around the world including across other disease areas in India and produced workable recommendations.
The report suggested setting up of 1) A national (or state) cancer fund that will help alleviate cancer associated catastrophic expenditure; 2) An autonomous committee of health and finance experts to help set realistic prices and oversee this ‘cancer fund’.
The fund’s inflow could draw from government programmes, small co-pays/premiums for those who can afford to pay into it, tax-free contributions from organisations/individuals and CSR money. The pooled fund could also grow, leveraging capital markets. We recognise this requires regulatory changes that allow investment of tax-free contributions, but it could be considered by the relevant authorities to make the fund sustainable. The fund itself could be used towards universal screening, expensive tests for rare cancers, additional insurance cover for long, targeted treatments, social support and counselling systems for patients and families. It could even approve soft loans for select, eligible, patient groups.
There could be other models as well. Cancer care and treatment warrant much more discussion than is happening in the country, and conversations need to include better data for which cases must be mandatorily notified, increased investment in R&D and regulatory reform. The world is forging ahead in the fight against cancer; India, known as pharmacy of the world should tackle this malady head on by among other things, coming up with the money to do so.
This article is authored by Anjali Nayyar, executive vice president, Global Health Strategies and Indira Behara, public health specialist, New Delhi.
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