In a recent report brought out, it has been noticed that Cancer care accounted for 34% of all tertiary claims. This particular claim has been made under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) in the first 11 months since its launch in September 2018. One of the data analyses by the National Health Authority shows that there is a risk of cancer cases even as the insurance scheme makes treatment accessible to many.
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The unfortunate fact in this is that women accounted for a higher number of claim submissions in all age-categories. The age group which had the highest numbers was between 45-50 years. While ovary, breast, cervix and radical hysterectomy were common among women, men who sought oncology services under the scheme either came for stage three of palliative treatment or with colon rectum and head and neck cancers.
NHA chief executive Indu Bhushan said “The analysis presents highlights of broad trends of the oncology services utilization and demand-supply scenario for the first 11 months under the scheme. This data is important as it can be used not only to align services and coverage under the scheme but also for better policy formation,”
The PMJAY is the government-funded health insurance scheme. It aimed to provide free health cover of Rs 5 lakh annually to more than 10.74 crore deprived families.
The analysis of the utilization of oncology services under the scheme also showed some variation according to different states:
As per the data, Tamil Nadu and Maharashtra together generated over 60% of all oncology claims. The reason behind this according to the analysis is Tata Memorial Hospital and Research Centre in Mumbai, followed by Government Super Speciality Radiology, Omandur in Tamil Nadu were the top hospitals catering to claims under oncology.
In Madhya Pradesh migration for cancer care is most prominent which is then followed by Uttar Pradesh, Bihar, Jharkhand, and Maharashtra. Around 80% of the beneficiary movement for cancer care services came from these states.
The unequal and disparity requires established uniform standards for prevention. For the diagnosis and treatment of cancer across the country, NHA the implementing agency for the scheme has partnered with National Cancer Grid.
What will the Grid do? The Grid helps in linking doctors and specialists across the country to enable standard care across the country while saving patients the hassle of traveling long distances to seek treatment.
The analysis has also said about the utilization of medical oncology packages, followed by radiation and surgical oncology. Over 80% of the total oncology claims were of medical oncology, whereas radiation oncology accounted for 13.8% and surgical oncology was 3.3%. Pediatric cancer accounted for 2.7% of total claims submitted for oncology services.
As per the experts, this has been done because most cancer cases in the country are diagnosed at a late stage. This leads to such patients being treated with palliative therapy part of medical oncology.
Overall, the majority (72%) of the claims were from private hospitals, except in six states or UTs which includes Andaman and Nicobar, Arunachal Pradesh, Chandigarh, Kerala, Mizoram, and Sikkim. These states generated no oncology claims at private hospitals.
The analysis points at differences in waiting for time, distance, equipment, availability of specialization and multifaceted cancer centers as some of the possible reasons for the gap between utilization of services in public and private sectors.
Helping the country cure cancer is extremely necessary. It should not be neglected at any cost and must have provisions to be improved in a better way.
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