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Written By: Editorial Team | Published : April 5, 2018 2:05 PM IST
Dr Pradeep Jain (Director) the Department of Laparoscopic GI, GI Oncology Surgery At Fortis Hospital,Shalimar Bagh Delhi: Universal Health Coverage: everyone, everywhere" has been declared as the theme for World Health Day 2018 by World Health Organisation. This concept implies that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. This is the key to ensure the ultimate aim of "Health to All" in a world where over 100 million people are pushed into poverty due to out of pocket expenses. Of this, more than 50% are from India. In India, cancer, affecting over 10 million people, can be singled out as the major disease which pushes families into heavy debt and poverty.
A visit to Government run cancer Hospital such as Tata Memorial Hospital is more than enough to bring into notice the financial and social burden that cancer subjects the patients and their caregivers. The entire footpaths and pavements outside the hospital are converted into a makeshift living space since the family members accompanying the sick cannot afford to rent an accommodation. Most of these patients have migrated from all over the country due to lack of availability of quality care back home. Most of them have sold off all of their properties and incurred heavy loans from moneylenders, friends and relatives in order to raise money for the care of their loved ones. Adding to it, they cannot spare time to earn a livelihood since they have to care for the patient. Also, it's not uncommon to see the children accompanying them as there is no one to take care of the children back home. As a result most of these children had to drop-out of school. Thus, one incidence of cancer is enough send families spiralling down the economic and social ladder. And this is the case when the cost of cancer treatment is subsidised in this government-run cancer care facility for below the poverty line (BPL) families. Cancer is an expensive disease right from the stage of diagnosis to finishing treatment and can cost many Lakhs. In a country with per capita income of Rs 42000, treatment of cancer is almost unaffordable for most of the families. Adding to this, the government facilities for cancer treatment have not expanded to keep pace with the demand, leading many untreated. This calls making the cancer care facilities in private sector affordable by subsidising the care in such facilities. This is where the Universal Health Coverage (UHC) comes into picture.
The Union Budget of 2018 has increased the amount allocated under Rashtriya Swasthya Bima Yojana from an amount of Rs 30000 per year per for BPL families to 5 Lakhs. This is one of the major steps as the country tries to move towards UHC. Empirical studies across the globe indicate that countries that have invested in UHC have been able to not only the improve the affordability of quality care to its population but also have been able to improve people's health and life expectancy. UHC encourages people who otherwise wouldn't go for medical advice at the first symptoms of disease to seek them more often. This results in regular health check-ups and therefore, early diagnoses of ailments like cancer. The increase in the insurance amount allocated under RSBY is expected to create similar improvements in health-seeking behaviour. In context of cancer care in India, it means reducing the disease burden by preventing 70% of cancer in the first place, and 80% reduction in the fatalities associated with cancer. However, given India's abysmally low health coverage of population at 27%, UHC is still a long way to go. It starts with improving penetration of medical insurances and making insurances available at a subsidised premium. It also calls for increasing the scale and quality of care. Measures such as promoting low-cost but high quality medicine, creating more number of quality healthcare facilities spread across the country and training more professionals to prevent, manage and cure the ailments. Financial affordability of care is a product of availability of care. Therefore, resolving the issues pertaining to availability of quality care should be central in improving affordability of care and thereby, achieving Universal Health Coverage.
