Financing Cancer Care in Low-Resource Settings
Authors: Felicia Knaul, Susan Horton, Pooja Yerramilli, Hellen Gelband, Rifat Atun
This chapter analyzes domestic health system financing in light of cancer’s requirement of expensive, complex, multimodal medical treatment for extended periods. Acute care costs can push already poor families deeper into poverty as they face catastrophic expenses from hospitalization and transportation. The move to universal health care (UHC) is reviewed for China, Ghana, India, Mexico, Thailand, Peru, Colombia, and Dominican Republic. All health insurance schemes have restrictions on which medical services are eligible for coverage; how these are determined crucially affects the equity and efficiency of a health system. Financial protection—based on prepayment, risk pooling, and public funding for the poor—is a cornerstone of efforts to achieve UHC and is the goal of many health system reforms. Co-payments that fall as country per capita income increases vary by type of service, but may deter patients from seeking care. Improved coverage translates to improved survival rates, while incentives to provide care are affected by whether payments to service providers are made on a capitation or fee-for-service basis.