Women accounted for higher number of claim submissions in all age-categories, with the highest numbers in the age group of 45-50 years. While ovary, breast, cervix and radical hysterectomy were common among women, men who sought oncology services under the scheme either came for stage three of palliative treatment or with colon rectum and head and neck cancers.
“The analysis presents highlights of broad trends of the oncology services utilisation and demand-supply scenario for the first 11 months under the scheme. This data is important as it can be used not only to align services and coverage under the scheme but also for better policy formation,” NHA chief executive Indu Bhushan told TOI.
PMJAY is the government-funded health insurance scheme that aims to provide free health cover of Rs 5 lakh annually to more than 10.74 crore deprived families.
The scheme offers 150 oncology packages.
The analysis of utilisation of oncology services under the scheme also highlights state-wise variation.
Tamil Nadu and Maharashtra together generated over 60% of all oncology claims. This is probably because Tata Memorial Hospital and Research Centre in Mumbai, followed by Government Super Speciality Radiology, Omandur in Tamil Nadu were the top hospitals catering to claims under oncology.
Migration for cancer care is most prominent in Madhya Pradesh followed by Uttar Pradesh, Bihar, Jharkhand and Maharashtra. These states accounted for 80% of the beneficiary movement for cancer care services.
To address the disparity and establish uniform standards for prevention, diagnosis and treatment of cancer across the country, NHA the implementing agency for the scheme has partnered with National Cancer Grid.
The Grid helps in linking doctors and specialists across the country to enable standard care across the country while saving patients the hassle of travelling long distances to seek treatment. The analysis also pointed at the higher utilisation of medical oncology packages, followed by radiation and surgical oncology. Over 80% of the total oncology claims were of medical oncology, whereas radiation oncology accounted for 13.8% and surgical oncology was 3.3%. Paediatric cancer accounted for 2.7% of total claims submitted for oncology services.
Experts say this could be because most cancer cases in the country are diagnosed at a late stage and therefore, such patients are generally treated with palliative therapy part of medical oncology.
Overall, majority (72%) of the claims were from private hospitals, except in six states or UTs which includes Andaman and Nicobar, Arunachal Pradesh, Chandigarh, Kerala, Mizoram and Sikkim. These states generated no oncology claims at private hospitals.
The analysis points at differences in waiting time, distance, equipment’s, availability of specialisation and multifaceted cancer centers as some of the possible reasons for the gap between utilisation of services in public and private sector.