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cover ) recent developments saying, “Niti Aayog recently has collaborated up with state governments with an aim to improve healthcare delivery. There has been a push for state governments to rely on public-private partnerships (PPP) to gather funds for public health. Consequently, there are increasing number of initiatives being brought about with an aim to improve infrastructure and increase awareness to ensure early detection of cancer.” Though the government is putting in all these efforts through initiatives and schemes, there is still a long way to go. Dr Katdare suggested, “The government needs to improve the amount provided for treatments in the government schemes like MJPJAY in Maharashtra, which will make the option economically more viable to private hospitals and increase the uptake of these schemes in private hospital, thus increasing the amount of patients who can be treated in these hospitals.” Dr Vikas Goswami, Senior Consultant, Dept of Medical Oncology, Fortis Hospital pointed out, “The biggest public sector contribution should be to increase universal insurance for cancer care and increasing the GDP in healthcare.” The role of the private sector India has come a long way from where it was two decades ago. But many challenges are yet to be addressed. The private sector, being a vibrant force, accounts for 82 per cent of the total $30.5 billion health sector expenditures in 2003 according to one reported survey. Taking into consideration the share held by the sector, the role of the private sector is very crucial. Kothari highlights, “In the private sector, many not for profit organisations like the Indian Cancer Society, Mumbai and Cancer Care Wing managed by Bhagwan Mahaveer Cancer Hospital & Research Centre, Jaipur are working towards spreading awareness, detection and cure of those who are affected with the disease. These not-for-profit organisations conducts early cancer detection camps especially for 24 February 2018 EXPRESS HEALTHCARE LEARNINGS FROM THE GLOBE In the US, total healthcare expenditure is pegged at $3.3 trillion and is more than 15 per cent of its GDP in 2016. Back in 2010, cancer care only constituted $124 billion dollars. Similarly, in the UK, the NHS reported that the total cancer care expenditure was around 5-6 per cent of total health spending.While many argue that increasing care treatment costs could become responsible for increasing healthcare spending, it would be unwise to deny that such spending has resulted in better infrastructure and access to better treatment methods.As each country has its own legal hurdles and policies for healthcare, strategies to tackle cancer vary greatly.With the number of uncertainties surrounding India’s healthcare ecosystem, a top-down approach is needed where the government intervenes at every level to work towards improving infrastructure and more importantly, making such facilities more accessible V THIYAGARAJAN MD, India Home Health Care As per the report of Euro Pancreatic Cancer Index (EPCI) 2014, published by the Sweden-based research organisation Health Consumer Powerhouse (HCP)- Netherlands comes out top with 879 of a possible 1,000 points, followed by Denmark (872), France (812), Ireland (807) and the UK in fifth position. Reason for this is very high quality of cancer research. In Finland, there is a long tradition of collecting samples in bio- banks, which makes genetic information readily accessible.These samples can be linked to comprehensive digital databases of donor health data, which benefits cancer research enormously. Bio-bank samples can be used, for instance, to examine the molecular features of cancer cells in order to find out which treatment works best for different types of cancer.With the help of this model, Finland, which was way behind many other European countries in cancer treatment, has come a long way and is now leading in cancer research and treatment.This research model proved a boon for the patients who were in distress due to higher cost of treatment. In a country like India where health insurance system is still in its initial phases of popularity, majority of patients settle their bills in cash.The research model adopted by countries like Finland can help enormously in reducing the treatment cost. More and more researches lead to better and cheap methods of treatment.Also, doctors/ clinicians, with the help of research papers, can identify the problem at the right stage leading to lesser diagnostics and investigations SANDEEP KOTHARI Vice Chairman – Bhagwan Mahaveer Cancer Hospital & Research Centre (BMCHRC) Most countries that are ranked by WHO in the top 15 countries in health care rankings either follow the Bismarck or the Beveridge Model. Hence, they find themselves rated so, since both of them follow a policy that falls under taxation, National Health Service, mandatory Insurance and public and private service with public taking the lead . India is a highly populated country with a WHO rating below 150. So it will need to study these models to find out how the public enterprise and the private enterprise have worked together to ensure better care and quality of life. Any country that has an over dependency on private health is bound to suffer and so is the case with public health dependency.There needs to be a fine balance between these two like the Yin and Yang. DINESH MADHAVAN Director Healthcare Services – HCG Enterprises underprivileged and also provides funds for the treatment. As per its latest Annual Report, BM- CHRC has spent approximately 2.4 crores in the last financial year on the treatment of those patients who can’t afford treatment and belongs to the weaker section of society. Similarly, Indian Cancer Society has spent around 87.13 crores on the treatment as per its Annual Report of 2016-17. These initiatives are good but there is a dire need that other Private players also joins in and create a pool which can be used for the treatment of cancer affected patients. Dr Katdare also adds that trust aided private hospitals need to be regularised and a regular audit of number of patients treated by them needs to be done. This will improve the amount of patients treated. Additionally, a certain percentage can be earmarked for superspecialties where treatment is costly like cancer and also as part of Corporate Social Responsibility for treatment of poorer patients. For eg. In global hospital, we have created affordable packages for cancer surgery wherein the in and out package for an uncomplicated stay is almost 30 per cent less than the a-la-carte charges. Suresh Ramu, Co-founder & CEO, Cytecare Hospitals mentioned about another important segment,"Diagnostics sector plays an integral element in providing cost efficiency during both diagnosis and treatment. There is a need to diagnose effectively with limited set of diagnostic tests rapidly so as to start the accurate treatment immediately. And even though there are vast innovations in the technology which can reduce the burden of the disease through precision and quality, these personalised treatments are expensive and frontloads the cost involved. Governance of care is an important aspect through which the cost of treatment can be reduced. We have deployed a multi-disciplinary tumour board which reviews all the patient treatments, and the plan of treatment is evaluated against the global standard to prevent recurrence. If the

( FOCUS:CANCER CARE recurrence of the disease is minimalised or managed, it could bring substantial reduction in the cost of cancer care." sector. Considering India’s vast population, crowdfunding may also soon be identified as one of the key measures that can be put to use manage cost of cancer treatment. Contribution towards building a pool could substantially reduce the economic burden of cancer. With Government aiming to bring down the cost of entire healthcare delivery system and cancer being a major concern on the list, we hope to soon reach the affordable cancer care in India. Ramping up insurance Despite these improvements, one major lag remains in the insurance sector, with India’s current insurance penetration rate standing at 3.42 per cent, which is far below the global average of 6.2 per cent. Moreover, cancer insurance, being a novel form of coverage, is a relatively new trend in the insurance industry. Even though it aims to mitigate the cost of cancer treatment, the market share is very less. Rakesh Wadhwa, CMO and EVP - Strategy & Retail Assurance, Future Generali India Life Insurance Company informed, “Insurance works on the fundamental principle of pooling of risk. With pooling of risk comes the effect of economies of scale. A large insured population shall provide an opportunity for providing health care for masses at an affordable cost. A large insured population shall also help health care providers to provide quality health care at multiple locations.” He further suggests,“Considering the population size, economic profile and limitation of healthcare infrastructure, In my opinion we need a system which is mix of government support and active participation from private healthcare provider. The government can come with universal health insurance scheme for all citizens covering major critical illnesses. The base level of cover can be provided free for people in economically weaker section of the society. The insurance companies can provide a top-up cover insurance to citizens charging affordable premiums and ensuring quality health care.” Examining the industry perspective, it is evident that the nation is far from achieving affordability and accessibility when it comes to chronic diseases like cancer. Having said that, we sure are on the path and bringing in cost efficiency, but requires effort from all stakeholders, be it government, hospitals, pharma companies or the insurance EXPRESS HEALTHCARE 25 February 2018

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