Ayushman Bharat – Implications in cancer treatment – An Interview with Dr. Krishnatreya

In the third of this 4-part series, Dr. Manigreeva Krishnatreya of Dr. Bhubaneswar Borooah Cancer Institute in Guwahati, Assam discusses the significance of Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana scheme and its implications for cancer treatment. He also discusses the potential benefit of linking cancer screening with Ayushman Bharat in the future.

Out-of-pocket expenditure is a significant factor that has driven many families to poverty in the country. In India, only a small segment of the population is covered by the health insurance scheme. Moreover, most of the health insurance providers are privately owned entities. Ayushman Bharat scheme or the Pradhan Mantri Jan Arogya Yojana (PMJAY) is Government of India’s attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service. The scheme aims to reduce the financial burden on poor and vulnerable groups arising out of hospital expenditures and to ensure their access to quality health services. Ayushman Bharat is touted to be World’s largest Government run health insurance scheme covering over 500 million beneficiaries from the poor and underprivileged section of India’s population.

Until recently, private insurance companies have been the most important providers for medical insurance in India. One of the main drawbacks of private insurance was that it was not a viable option for the economically backward section of society. Can you tell us about the Indian government’s new initiative – Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana schemes?

 What are some of the salient features of the PM-JAY scheme?

The best part of the scheme is that there are no premiums that need to be paid by a beneficiary and enrollment is for families whose annual family income is less than $7500 or INR 500,000. The PM-JAY is one significant step towards the achievement of Universal Health Coverage and Sustainable Development Goal – 3 set by the United Nations. Various agencies under the National Health Agency implement the health insurance scheme. The scheme covers medical and hospitalization expenses for almost all secondary care and most tertiary care procedures. Till now, 1350 medical packages covering surgery, medical and daycare treatments including medicines, and diagnostics have been included in the Ayushman Bharat scheme. Around 16,000 hospitals across the country are empaneled under the scheme, and nearly 3.5 million beneficiaries have received treatment under the scheme since its launch in September 2018, in both private and government run health centers.

Will Ayushman Bharat also cover cancer?

Earlier, the prime focus of the Government of India’s health program was for primary healthcare on Reproductive, Maternal, Newborn, Child and Adolescent Health and communicable diseases like Malaria, Tuberculosis etc. However, given the epidemiological transition, now non-communicable diseases account for nearly 62% of deaths among men and 52% among women, most of which are premature deaths. Now, the focus has shifted to non-communicable diseases like cancer. Having said that, the problem herein lies the availability of cancer care centers in each nook and corner of the country, which is further compounded by the affordability of standard cancer treatments. Many families were pushed to poverty due to catastrophic health expenditures for cancer treatment.

What treatments does Ayushman Bharat cover under cancer care?

Under the Ayushman Bharat scheme, surgical, radiation, and chemotherapy treatments for cancer are covered under various packages including expensive therapies like Immunotherapy. Working in a cancer hospital, I have seen the despair in the face of near and dear ones of a cancer patient when they learn about the cost of treatment. Earlier, nearly 40% of cancer patients registered at our hospital failed to turn up for their cancer treatment. Fortunately, due to Ayushman Bharat scheme this figure is now coming down, and we hope in the future, no person shall be left to die without offering a chance of cure by standard cancer treatments available. One of the interesting value addition of Ayushman Bharat is that, it covers the cost of travel by a cancer patient for treatment and check-up as well.

How can we improve the survival rates of Cancer in India? Any recommendations or suggestions?

Currently, cancer screening in the country is done on voluntary participation of individuals. In India, cancers of oral cavity in men and women, and breast and uterine cervix in women are regarded as common cancers. These common cancers are amenable for early diagnosis by cancer screening. Cancer screening is done by Visual Examination for mouth cancer, and Clinical Breast Examination and Visual Inspection with Acetic acid for breast and uterine cervical cancers, respectively. More than 200,000 patients with common cancers are detected each year in the country, and most of the cancers of oral cavity, breast, and uterine cervical cancers are detected at advanced stages leading to poor outcomes to treatment. Our limited experience has shown that voluntary participation by vulnerable men and women in cancer screening is extremely poor. This could be due to poor health-seeking behavior, ignorance, false beliefs, and lack of health awareness among the lay public. My recommendation is that, renewal of health insurance by an individual beneficiary or enrollment of new beneficiary should be done after a single-round of common cancer screening, and it can be done within the National Operational Framework and Guidelines for Common Cancer Screening (http://cancerindia.org.in/wp-content/uploads/2017/11/Operational_Framework_Management_of_Common_Cancers.pdf). The Government’s Primary Health Care setting can be utilized to carry the cancer screening services. Healthcare professionals, including primary health workers, can be easily trained to perform cancer screening. This will help to improve the survival of patients with these common cancers. In fact, around 100,000 lives can be saved annually by merely linking the National Health Protection Mission or Ayushman Bharat with cancer screening in an eligible population of the country.

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