Financial support systems for cancer care in India: A qualitative exploratory study

The financial toxicity (FT) of cancer care adversely impacts treatment initiation, compliance and completion in low-and middle-income countries like India. This qualitative study aimed to map the financial support systems for cancer care and associated barriers and facilitators in India.

Semi-structured interviews were conducted with oncologists working in various settings (public/private, for-profit/not-for-profit, urban/rural). A deductive classification was first applied to organise support system resources into two categories: (1) resources for treatment centres and (2) resources for patients. This was followed by an inductive approach to identify barriers/drawbacks and facilitators until saturation was reached.

A total of 19 oncologists across 9 Indian states were interviewed. Support for treatment centres was reportedly obtained through donations, not-for-profits, corporate social responsibility (CSR, the integration of social and environmental concerns into business operations), research grants and loans. Donor expectations, rigid and outdated insurance protocols, and delayed reimbursement were barriers to funding, while networking with donors, hiring professionals to scout for resources, and publication of outcomes enabled funding. For patients, private and public insurance, donations, pharmaceutical company schemes and not-for-profit subsidies were the major resources. Documentation burden, low awareness, insurance denials, and geographical inaccessibility were barriers, while doctors' motivation, not-for-profit advocacy, and employing financial counsellors facilitated funding.

Despite diverse funding mechanisms, financial support for cancer care in India remains fragmented and difficult to access. Addressing systemic inefficiencies and expanding patient-centred financial support mechanisms are essential to reducing financial toxicity and improving equitable access to cancer care in India.

Recommended policy changes include embedding financial navigation in hospitals, training community-level financial counsellors, instituting national FT monitoring, and streamlining public insurance applications and reimbursement. Support for non-medical and indirect costs may be expanded through pensions, food rations, subsidised transport, education and employment opportunities for affected families.