Financing Cancer Care in Low-Resource Settings

Excerpt

Cancer accounts for a rapidly growing health and economic burden in low- and middle-income countries (LMICs) (Knaul and others 2014). The long-term nature of chronic and noncommunicable diseases that characterizes many cancers inflicts repeated financial onslaughts on families, intensifying the poverty-illness cycle. Inadequately treated illnesses deepen poverty, leading to a cycle of loss of health, lack of treatment, higher morbidity, lost income, and deeper impoverishment (Atun and Knaul 2012).

Many LMICs are working to achieve greater, and even universal, financial protection in health care, with funding from domestic sources that combines public insurance and prepayment. Establishing universal entitlement to key services through guaranteed benefits packages is a cornerstone of these efforts. These countries face challenges as they strive to include cancer and other chronic and noncommunicable diseases in the package of covered services. The inclusion of cancer interventions poses a specific set of challenges because of the chronic nature of the illness and the high costs of treatment.

An effective response to cancer requires strengthening all health system functions—stewardship, financing, service provision and delivery, and resource generation—along the entire, six-component, care-control continuum—primary and secondary prevention, diagnosis, treatment, survivorship, rehabilitation, and palliative care and pain control (Hewitt, Greenfield, and Stovall 2005; Knaul, Alleyne, and others 2012). The failure to adequately manage one of the components can jeopardize the entire response, resulting in premature deaths, unnecessary pain, and wasted resources. Although responding to all facets of the continuum is a daunting task, several countries have included cancer care in recent reforms designed to achieve universal health coverage (UHC); these reforms provide useful lessons for other countries.

This chapter analyzes one health system function—financing—in relation to cancer, focusing on treatment. The analysis draws on experiences from several middle-income countries (MICs) in which domestic finance is used and efforts are underway to achieve universal coverage. We draw lessons for other components of cancer care and control and highlight the importance of developing strategies for financing that consider all aspects of the care continuum and strengthening of health systems.

Our analysis focuses on how domestic sources of funding are deployed to finance cancer care; we leave for later work the issues of how these funds are sourced and collected. Domestic funding in the vast majority of LMICs does, and will inevitably continue to, pay for the bulk of cancer care. We do not focus on global and regional financing and platforms; this is a topic for future research. These platforms are especially important sources of finance for the poorest countries, for catalyzing discovery and innovation and for aggregating demand to reduce the costs of medicines and vaccines.