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癌症护理与经济负担——一篇综述

Cancer care and economic burden-A narrative review.

作者信息

Muralidharan Shrikanth, Gore Manisha, Katkuri Sushma

机构信息

PhD Scholar, Faculty of Medical and Health Sciences, Symbiosis Community Outreach Programme and Extension, Symbiosis International (Deemed University), Lavale, Tal: Mulshi, Pune, Maharashtra, India.

Assistant Professor, Faculty of Medical and Health Sciences, Symbiosis Community Outreach Programme and Extension, Symbiosis International (Deemed University), Lavale, Tal: Mulshi, Pune, Maharashtra, India.

出版信息

J Family Med Prim Care. 2023 Dec;12(12):3042-3047. doi: 10.4103/jfmpc.jfmpc_1037_23. Epub 2023 Dec 21.

Abstract

Cancer care poses a significant economic burden in India, where noncommunicable diseases contribute to a large number of deaths and disability-adjusted life-years. Despite economic growth, equitable wealth distribution remains a challenge, leading to inequalities in healthcare access. India's healthcare system is primarily privatized, financed through out-of-pocket expenditure (OOPE), and lacks coverage for a majority of the population. As a result, individuals without financial means face catastrophic health consequences when seeking necessary healthcare. OOPE in India's healthcare system is a major concern, with medicines accounting for a significant portion of expenses, followed by diagnostic tests and consultation fees. Nonmedical expenses also contribute to the financial burden. Cancer care specifically faces substantial financial challenges, with high treatment costs, reduced workforce participation, and the need for distress financing. Cancer-related OOPE is predominantly borne by patients and their families, leading to significant financial strain. The lack of comprehensive health insurance coverage and limited access to publicly funded healthcare services exacerbate the problem. Catastrophic health expenditure (CHE) in cancer care is prevalent, pushing households into financial distress and potentially impoverishment. Efforts have been made to address this issue, such as increasing public spending on healthcare and implementing health insurance schemes. However, challenges remain in ensuring their effectiveness and reach. The role of family care physicians is crucial in supporting patients and their families during catastrophic health expenditures related to cancer-related palliative care. They coordinate care, provide advocacy, emotional support, symptom management, and facilitate end-of-life discussions. Comprehensive measures are needed to strengthen healthcare infrastructure, improve access to affordable cancer care, enhance health insurance coverage, and implement supportive measures for cancer patients. Additionally, promoting preventive measures and early detection can help reduce the need for expensive treatments and decrease the risk of catastrophic health expenditures.

摘要

在印度,癌症治疗带来了巨大的经济负担,该国的非传染性疾病导致大量死亡和伤残调整生命年。尽管经济有所增长,但公平的财富分配仍是一项挑战,导致医疗保健可及性方面的不平等。印度的医疗保健系统主要是私有化的,通过自费支出(OOPE)来融资,并且缺乏对大多数人口的覆盖。因此,没有经济能力的个人在寻求必要的医疗保健时会面临灾难性的健康后果。印度医疗保健系统中的自费支出是一个主要问题,药品占费用的很大一部分,其次是诊断测试和咨询费。非医疗费用也加重了经济负担。癌症治疗尤其面临巨大的经济挑战,包括治疗成本高昂、劳动力参与度降低以及急需应急资金。与癌症相关的自费支出主要由患者及其家庭承担,导致巨大的经济压力。缺乏全面的医疗保险覆盖以及获得公共资助医疗服务的机会有限,使问题更加严重。癌症治疗中的灾难性医疗支出(CHE)很普遍,使家庭陷入经济困境并可能导致贫困。已经做出努力来解决这个问题,例如增加医疗保健方面的公共支出和实施医疗保险计划。然而,在确保其有效性和覆盖面方面仍然存在挑战。家庭护理医生在与癌症相关的姑息治疗导致的灾难性医疗支出期间支持患者及其家庭方面发挥着关键作用。他们协调护理、提供支持、情感支持、症状管理并促进临终讨论。需要采取综合措施来加强医疗保健基础设施、改善获得负担得起的癌症治疗的机会、扩大医疗保险覆盖范围并为癌症患者实施支持性措施。此外,推广预防措施和早期检测有助于减少昂贵治疗的需求并降低灾难性医疗支出的风险。

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