Study Advocates for Enhanced Cancer Coverage and Early Diagnosis Under Ayushman Bharat
India's flagship health insurance program, Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), has proven to be a critical lifeline for cancer patients, offering financial protection and timely access to care that would otherwise be unattainable for many. However, a recent study reveals significant gaps in annual funding and requirements, urging policy reforms to maximize the scheme's impact.
Key Findings from the FinCan Study
The FinCan study, conducted by oncologists and health economists led by Dr. Abhishek Shankar from the Department of Radiation Oncology at DRBRAIRCH under AIIMS Delhi, provides fresh insights into AB-PMJAY's strengths and areas for improvement. Since its inception in 2018, the scheme has covered over 68 lakh cancer treatments worth approximately Rs 13,000 crore, particularly benefiting rural and low-income populations. Targeted therapies have played a significant role in this outreach, marking a crucial advance in modern oncology.
Research published in The Lancet indicates that enrollment under AB-PMJAY increased the likelihood of initiating cancer treatment within 30 days of diagnosis by about 90% compared to pre-2018 levels. Despite this progress, the FinCan study highlights a substantial funding shortfall. Delivering the full five-year Standard of Care for cancer—including diagnostics, surgery, targeted drugs, radiotherapy, and follow-up—would require an estimated Rs 33,000 crore annually. Currently, AB-PMJAY allocates only about Rs 7,700 crore per year for cancer under its existing package structure.
Proposed Reforms for Smarter Spending
Dr. Shankar emphasized that better cancer care involves not just increased spending but smarter allocation of resources. "Early diagnosis and well-designed coverage can prevent both late-stage suffering and catastrophic costs," he stated. The study's models show that expediting diagnosis and treatment initiation could save about Rs 1,500 crore annually and result in 1,560 additional survivors each year. Furthermore, early detection through screening aligned with OECD benchmarks could lead to annual savings of Rs 5,000 crore and save over 30,000 lives annually.
Policy recommendations from the study focus on restructuring AB-PMJAY to better reflect the real-world costs of cancer care. Key proposals include:
- Revolving Ceiling: Replace the current Rs 5 lakh annual cap with a five-year "revolving ceiling" of Rs 25 lakh per family. This would allow patients to use more funds in high-cost years, such as the first year of treatment, ensuring continuity of care without financial interruption.
- Top-Up for High-Stage Cancers: Introduce a Rs 10 lakh top-up for about 30-37% of patients with high-stage cancers requiring expensive treatments, while early-stage cases remain self-sustaining under the revolving ceiling.
- Embedded Diagnostics and Screening: Integrate diagnostic coverage and screening support into the scheme. Currently, diagnostics account for just 3% of total cancer care costs but often fall outside AB-PMJAY, causing delays in treatment. Incorporating these elements via Health and Wellness Centres under the National Health Mission or within AB-PMJAY packages could save lives and reduce costs.
Government Initiatives and Future Directions
India's policymakers have already taken steps to address these issues. The 2025-26 Union Budget allocated funds to establish 200 new day care cancer centres in district hospitals, aiming to expand access and reduce out-of-pocket expenses. Additionally, customs duties on several lifesaving cancer drugs were cut or exempted, helping to lower medicine costs.
In summary, while AB-PMJAY has undeniably expanded access to cancer treatment, accelerated treatment initiation, and alleviated some financial burdens, the FinCan study identifies untapped potential. Strengthening early detection, redesigning benefit ceilings, and embedding diagnostic and long-term follow-up care are crucial for enhancing the scheme's effectiveness. Through strategic and smarter spending, India can not only save more lives but also reduce the economic burden of cancer on households, reinforcing AB-PMJAY's role in achieving Universal Health Coverage.
