title: Delivery of affordable and equitable cancer care in India.
abstract: The delivery of affordable and equitable cancer care is one of India's greatest public health challenges. Public expenditure on cancer in India remains below US$10 per person (compared with more than US$100 per person in high-income countries), and overall public expenditure on health care is still only slightly above 1% of gross domestic product. Out-of-pocket payments, which account for more than three-quarters of cancer expenditures in India, are one of the greatest threats to patients and families, and a cancer diagnosis is increasingly responsible for catastrophic expenditures that negatively affect not only the patient but also the welfare and education of several generations of their family. We explore the complex nature of cancer care systems across India, from state to government levels, and address the crucial issues of infrastructure, manpower shortages, and the pressing need to develop cross-state solutions to prevention and early detection of cancer, in addition to governance of the largely unregulated private sector and the cost of new technologies and drugs. We discuss the role of public insurance schemes, the need to develop new political mandates and authority to set priorities, the necessity to greatly improve the quality of care, and the drive to understand and deliver cost-effective cancer care programmes.
authors.affiliation: Tata Memorial Centre, Mumbai, India. Electronic address: prameshcs@tmc.gov.in.
authors.forename: C S
authors.initials: CS
authors.lastname: Pramesh
authors.affiliation: Tata Memorial Centre, Mumbai, India.
authors.forename: Rajendra A
authors.initials: RA
authors.lastname: Badwe
authors.affiliation: Dr B Borooah Cancer Institute, Guwahati, India.
authors.forename: Bibhuti B
authors.initials: BB
authors.lastname: Borthakur
authors.affiliation: Kamala Nehru Memorial Hospital, Allahabad, India.
authors.forename: Madhu
authors.initials: M
authors.lastname: Chandra
authors.affiliation: Cancer Institute Adyar, Chennai, India.
authors.forename: Elluswami Hemanth
authors.initials: EH
authors.lastname: Raj
authors.affiliation: MNJ Institute of Oncology, Hyderabad, India.
authors.forename: T
authors.initials: T
authors.lastname: Kannan
authors.affiliation: Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kalwar
authors.affiliation: Army Hospital (Research and Referral), Delhi, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kapoor
authors.affiliation: Birla Cancer Center, SMS Medical College Hospital, Jaipur, India.
authors.forename: Hemant
authors.initials: H
authors.lastname: Malhotra
authors.affiliation: Regional Cancer Centre, Cuttack, India.
authors.forename: Sukdev
authors.initials: S
authors.lastname: Nayak
authors.affiliation: All India Institute of Medical Sciences, Delhi, India.
authors.forename: Goura K
authors.initials: GK
authors.lastname: Rath
authors.affiliation: Cancer Institute Adyar, Chennai, India.
authors.forename: T G
authors.initials: TG
authors.lastname: Sagar
authors.affiliation: Regional Cancer Centre, Thiruvananthapuram, India.
authors.forename: Paul
authors.initials: P
authors.lastname: Sebastian
authors.affiliation: Tata Memorial Centre, Mumbai, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sarin
authors.affiliation: Cancer Institute Adyar, Chennai, India.
authors.forename: V
authors.initials: V
authors.lastname: Shanta
authors.affiliation: Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Suresh C
authors.initials: SC
authors.lastname: Sharma
authors.affiliation: Gujarat Cancer and Research Institute, Ahmedabad, India.
authors.forename: Shilin
authors.initials: S
authors.lastname: Shukla
authors.affiliation: Kidwai Memorial, Bangalore, India.
authors.forename: Manavalan
authors.initials: M
authors.lastname: Vijayakumar
authors.affiliation: Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: D K
authors.initials: DK
authors.lastname: Vijaykumar
authors.affiliation: Guy's and St Thomas' Hospital, Institute of Cancer Policy, King's College London, London, UK.
authors.forename: Ajay
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: King's Health Partners Cancer Centre, King's College London, London, UK.
authors.forename: Arnie
authors.initials: A
authors.lastname: Purushotham
authors.affiliation: King's Health Partners Cancer Centre, King's College London, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Sullivan
mesh_terms: D003695:Delivery of Health Care / Q000191:economics*; D006291:Health Policy / Q000191:economics*; D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D007194:India; D009369:Neoplasms / Q000191:economics* / Q000628:therapy; D012959:Socioeconomic Factors