|LETTER TO THE EDITOR
|Ahead of print
Linking of National Health Protection Mission with cancer screening in eligible population of India
Department of Cancer Registry and Epidemiology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
|Date of Submission||15-Jul-2019|
|Date of Decision||14-Jan-2020|
|Date of Acceptance||07-Feb-2020|
|Date of Web Publication||14-Sep-2020|
Department of Cancer Registry and Epidemiology, Dr. B Borooah Cancer Institute, Guwahati, Assam
Source of Support: None, Conflict of Interest: None
Out-of-pocket expenditure is a major factor that has driven many families to poverty in India. In India, a small segment of its population is covered by the health insurance scheme. Moreover, most of the health insurance providers are privately owned entities. Ayushman Bharat (AB) scheme or the Pradhan Mantri Jan Arogya Yojana (PMJAY) is the 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 the World's largest government-run health insurance scheme covering 500 million beneficiaries from the poor and underprivileged section of India's population. The best part of the scheme is that there are no premiums that need to be paid by a beneficiary, and the family is entitled to the financial assistance of $7500 or INR 500,000 per year. The PM-JAY is one significant step toward the achievement of Universal Health Coverage and Sustainable Development Goal-3 set by the United Nations. The health insurance scheme is implemented by various implementing agencies under the National Health Agency. The scheme covers medical and hospitalization expenses for almost all secondary care and most tertiary care procedures. Till now, 1,350 medical packages covering surgery, medical and daycare treatments including medicines and diagnostics have been included in the Ayushman Bharat scheme. More than 21,000 hospitals across the country are empaneled under the scheme and more than 120 million e-cards (73 million AB-PMJAY cards + 48 million state cards) have been issued under the scheme since its launch in September 2018, in both private- and government-run health centers.
In India, cancers of the 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. With an average crude incidence of 30 per 100,000 population of common cancers, around 360,000 patients with cancers of the oral cavity, breast, and uterine cervix will be detected each year in the country, and most of these patients are diagnosed at advanced stages leading to poor outcomes to treatment. Our limited experience has shown that voluntary participation by vulnerable men and women in population-based 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 the renewal of health insurance by an individual beneficiary or enrollment of a new beneficiary should be done after a single round of common cancer screening, and which can be done within the National Operational Framework and Guidelines for Common Cancer Screening. The Government's primary health care setting can be utilized to carry the cancer screening services. Health care professionals including primary health workers can be easily trained to perform common cancer screening. This will help to improve the survival of patients with these common cancers. Considering 50% of deaths due to advanced-stage presentation of common cancers, more than 150,000 lives can be saved annually by simply linking of National Health Protection Mission or Ayushman Bharat with cancer screening in an eligible population of the country.
Ministry of Health and Family Welfare, Government of India is embarking on a pilot project for common cancers screening in six districts of the country. A meeting for the strengthening of the continuum of cancer care was held at New Delhi from 17th to 19th July 2019 by engaging representatives from the National Health Mission and selected tertiary care cancer institute of states where the screening will be done. In the meeting, I raised this matter and the idea was lauded by one and all present. A member from the National Health Authority, which is the implementing agency for PMJAY nationally opined that such linking of prior common cancers screening with PMJAY will require more time, as in some instances e-cards are issued under emergency care setting. Having said that, all difficulties in such linking can be overcome in due course and this will be a “game-changer” for cancer screening in India.
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Conflicts of interest
There are no conflicts of interest.
| » References|| |
Chatterjee P. India launches Ayushman Bharat's secondary care component. Lancet 2018;392:997.