Improving cancer care in India - challenges and path forward

With the rising burden of cancer in India, there is a pressing need for specialised care for different types of cancer.

By Jyotsna Govil  

Cancer care in India has made remarkable progress, with the government taking significant steps to improve accessibility and affordability. The exemption of three cancer medicines from customs duty in the last Union Budget reflects a strong commitment to tackling this pressing challenge. However, further efforts are needed to enhance affordability and ensure timely, quality care. The upcoming Union Budget 2025 presents an opportunity to address this growing health crisis. Investments in infrastructure, local medicine manufacturing, and universal health coverage, alongside stronger public health programmes and preventive measures, can reduce the disease's economic and emotional toll. This budget must focus on equitable, cost-effective solutions to tackle a challenge that has persisted for decades.

The burden of non-communicable diseases (NCDs), such as cancer, surged in the mid-1950s, driven by lifestyle shifts and longer life spans. Initially underestimated due to their non-contagious nature, cancer cases created a burden on government hospitals by the late 20th century, exposing gaps in specialised care. This growing demand led to the rise of specialised oncology centres by private healthcare providers, which addressed the crisis with advanced diagnostics and treatments, playing a crucial role in managing the escalating prevalence of cancer.

With the rising burden of cancer in India, there is a pressing need for specialised care for different types of cancer, access to advanced diagnostic and treatment equipment, and affordable healthcare solutions to address the high treatment costs. Despite the government's efforts to provide health coverage through schemes like Ayushman Bharat, a significant gap persists in public awareness regarding the importance of health insurance. Many citizens fail to fully grasp its value, leaving them vulnerable to financial crises during medical emergencies.

Ayushman Bharat payouts estimate the economic cost of cancer to the nation at a staggering ₹75,000 crore (15 lakh patients at ₹5 lakh per patient). A March 2022 World Health Organisation (WHO) report revealed that high out-of-pocket expenditures (OOPE) on healthcare push approximately 55 million Indians into poverty annually, with over 17% of households facing catastrophic health-related expenses every year. Cancer patients and their families often bear the brunt of these financial challenges, underscoring the urgent need for greater awareness, accessible health insurance, and affordable cancer care.

High Tariffs and Duties: A Barrier to Affordability

Cancer treatment has become increasingly complex, with many types of cancer requiring specialised treatments. Each promises better chances of a cure but at a higher cost. Unlike other diseases, which have fewer standardised procedures, cancer treatment requires specialised doctors, adding to the complexity and cost of treatment. A major hurdle to affordable cancer care is the high import duties on medical equipment, with taxes as high as 36%. This significantly increases the cost of treatment, especially for mid-sized operators, limiting their ability to offer competitive pricing, particularly in smaller cities. Another major challenge is the lack of infrastructure, especially in government hospitals, where equipment is not regularly maintained, and there is a shortage of trained personnel to operate advanced machines like proton therapy. Coupled with high operational and maintenance costs, even for simpler equipment like mammography devices, they make cancer treatments less accessible.

In almost all cases, the equipment used is imported, and the lack of subsidies or exemptions on import duties for high-end machines and equipment—36% import duties and taxes—contributes significantly to the high cost of treatment in hospitals. One possible way of bringing down costs would be for the government to reduce these duties and invest more in equipping hospitals with high-end machines to make advanced cancer care more accessible and affordable. As competition increases, particularly in smaller markets, affordability will improve. Lower tariffs and a more competitive landscape will drive down costs and extend cancer care to underserved regions.

Way Forward: Fostering Affordability and Access

The need of the hour is to promote local manufacturing of medical equipment and medicines for cancer treatment. India must develop self-reliance in producing vaccines and treatments for NCDs, including cancer. Additionally, reducing the high-profit margins on cancer medicines—often between 40-90%—would ease the financial burden on patients. Lowering these margins, coupled with reduced import duties, would play a critical role in making cancer treatment more affordable across the country.

Prevention should be a top priority. Public health professionals must sensitize stakeholders across the healthcare ecosystem to the realities of this challenging disease. Primary healthcare centres, as the first point of contact for patients, need support to provide quality and affordable care, allowing tertiary hospitals to focus on NCDs and specialised treatments. Equipping every tertiary government hospital with cutting-edge equipment and infrastructure is essential to ensure quality cancer care.

Policymakers should also differentiate between various cancer types—curable, advanced, metastatic, and chronic—to ensure targeted support. Rare cancers require additional resources and consistent policies to address their unique challenges.

For follow-up care in cancer, rehabilitation services and the availability of prosthetics are essential for patients to restore physical function, manage pain, and improve their quality of life. Rehabilitation and prosthetics support patients in adapting to physical changes post-surgery, such as with breast, limb, and eye prosthetics. Rehabilitation also addresses emotional and psychological challenges, contributing to a holistic recovery journey and empowering patients to adapt to post-surgery changes and rebuild their lives.

(Jyotsna Govil, Chairperson, Indian Cancer Society, Delhi Branch.)

Views are personal, and do not represent the stand of this publication.