Implementation challenges of government-funded health schemes for cancer treatment at Tata Memorial Centre.

Background: The study aims to understand the Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY)health scheme awareness, challenges faced by the scheme beneficiaries, facilitators and out-of-pocket expenditure (OOPE) for cancer treatment at Tata Memorial Hospital, Mumbai.

Methods: We conducted an observational cross-sectional study approved by the Tata Memorial Centre Ethics Committee. We collected data by interviewing participants through a structured questionnaire.

Results: Out of 515 participants, 489 (95 %) were beneficiaries (patients/caregivers) of the schemes, 15 (2.9 %) MJPJAY staff, 6 (1.1 %) medical social workers (MSW), and 5 (1.0 %) AB PM-JAY staff. Of the 489 beneficiaries, only 162 (33.1 %) were aware of the scheme. Most patients were satisfied with the benefits of the scheme; of the 83 (17 %) who were dissatisfied, 30 (36 %) cited incomplete coverage at a 95 % Confidence Interval (CI) [0.26-0.46] and 19 (23 %) 95 % CI [0.14-0.32] cited OOPE as the reason for dissatisfaction. Participants opined a need to increase package coverage of cancer treatment and essential investigations. The beneficiaries highlighted delays in the approval process and technical issues of the scheme as potential areas of improvement.

Conclusion: Government health schemes are effective in improving treatment completion without impoverishment and have the potential to improve treatment outcomes and cancer survival. Study results indicate the need to increase awareness about these schemes in the general population, improving the health benefit packages for cancer treatment, with inclusion investigations, supportive care, nutritional care, palliative care, immunotherapy, chemotherapy drugs, targeted therapy, bone marrow transplantation, and hormonal therapy.

Policy Summary: Government-funded health schemes are effective in reducing impoverishment related to healthcare costs and promoting Universal Health Coverage. However, periodic review of the breadth of coverage as well as feasibility of completing treatment using these packages is necessary to eliminate out-of-pocket expenditure and facilitate treatment completion.