What does it take to be an uninsured cancer patient in India?finds out.In 2010, 28-year-old Tina was taken to a top hospital in Delhi after she noticed a lump on her breast. Her doctor told her that she had developed breast cancer. But there was one part of diagnosis that no one discussed with her: cost of her treatment. Even though her cancer was diagnosed at an early stage, her family had to shell out a lakh per month, for almost a year, for a drug called Herceptin . By the time, she reached home, they had to sell her gold to pay for her treatment.Almost every oncologist in Delhi’s Indraprastha Apollo Hospital has his/her own share of stories of patients like Tina who couldn’t afford medical treatment. Ramesh Sarin, Senior Consultant, Cancer Surgery , at the hospital says that majority of her patients are not able to afford targeted drugs used in cancer treatment, which can costs the patient up to Rs.20 lakh. “It is quite common to find patients discontinue treatment in the middle, as they are not able to afford it.”India has an estimated 1 million cases of cancer and 700,000 cancer deaths according to a 2012 GLOBOCAN report. The problem is compounded by the fact that it does not have any organized national cancer screening programmes. Further, there is an unequal distribution of care providers in northern and southern states.“Five years ago, the number of new cases diagnosed in our hospital was 250; today it has become 500. This spike is definitely a great cause of concern,” says Anish Maru, Senior Consultant, Action Cancer Hospital.According to the research of King’s College London, cancer is one of the most expensive diseases to treat. “In a study of 2204 households in five resource-poor rural settings in India, the cost of chronic illness, especially cancer was much higher than that of communicable diseases,” states a report on cancer care in India, published in Lancet Oncology.At a private hospital in India, a head and neck cancer patient shells out as much as nearly Rs200, 000 for surgery. “Currently, a stage 2 patient spends an additional Rs 1.5 lakh for IMRT. If it’s stage 3, they might have to spend an additional Rs 70, 000 for chemotherapy. Indian version of drugs like Herceptin costs Rs 57, 500 per vial, while Rituximab costs Rs.50, 000 per cycle,” adds Dr. Maru.Professor Richard Sullivan, Director, Institute of Cancer Policy and lead author of the series paper on Cancer Research in India , says that access is about providing high quality and affordable cancer care that patients trust.“How this is done depends on local situations - in some states this is about having proper insurance policies, in others free at point of care public hospitals. States also need to ensure that services are high quality and this requires peer review and continual assessment and benchmarking against agreed clinical guidelines.“Reducing burden even in poorest settings is firstly a matter of prevention; and for India one of the most critical issues is tackling smokeless tobacco. For screening work by Tata Memorial Centre and others has shown how cost effective visual inspection and acetic acid are for cervical cancer screening. Beyond this though there is no evidence that breast mammography, for example, is cost effective. Crucially any early detection strategies must first be trailed on patient population in question,” adds Sullivan.Though the government has rolled out insurance schemes like Rashtriya Swasthya Bima Yojana Rajiv Arogya Sri scheme, it often cover only a very small part of the expense incurred by the patient.“Only about 15 percent of the country’s population is covered by some form of health insurance. Further, those who are having health cover are largely under-insured. Average policy amount of health plans sold in 2011 was about Rs1.9 lakh and average bill of a cancer patient is nearly Rs10 lakh,” says Anil Chopra, Group CEO, Bajaj Capital.The cost of setting up an oncology unit is often considered as the major reason for the spiraling cost of cancer care. “Today, a linear accelerator costs from Rs 6 crores to Rs 18-19 crores, based on the range of work that it can do. Further, the import duty makes it more expensive. If you look at the surgical part of it, a cyber -knife costs around Rs 20- 23 crore,” explains Dr. Harit Chaturvedi , Chairman Max Institute of Oncology.A common impediment in the industry is acquisition of devices. Majority of Indian hospitals import more than 70 percent of their technology and devices today. Often medical device companies don’t take in to account the requirement of the Indian market. So, access to latest technology is often not available for small players. Despite, the grim scenario, there are a few initiatives which roll out affordable cancer screening devices made-in- India. However, these successful initiatives tend to be small.But how high is cancer treatment in India? And how much worse is it than countries like US and UK? “Cancer care is expensive across the globe. The per capita income of an Indian patient is lesser than one developed countries, so it becomes prohibitively expensive for him,” says Dr. Shyam Aggarwal , Senior Consultant, Oncology at Gangaram Hospital.So is cancer treatment only for the rich? It’s a question more policy makers should be asking. In Indian healthcare market new drugs are launched every day. But out of the 20 major drugs used in cancer care, only two or three are manufactured in India. “Entry of more Indian players will drastically reduce the cost of care. There is one drug made by Indian company which is Rs 8000, compared to its foreign counter part which costs almost a lakh,” says Ramesh Sarin.“The failure to detect cancer in an early stage often leads to high cost of care,” explains Sarin. “If a patient comes to the hospital at an early stage, a simple surgery might cure them. If the cancer is detected at advanced stage, even doctors push targeted drugs as it promises cure.”