The reimbursements that government-funded and private health insurance schemes now provide do not protect breast cancer patients in India from financial hardship associated with the treatment and related costs, health researchers have said.

This is particularly so because non-medical expenses on accommodation, food or travel directly related to treatment — but not covered under insurance schemes — made up 44 per cent of the overall costs, the researchers found. Medical costs account for the remaining 56 per cent.

The researchers have found that reimbursement levels ranged from 92 per cent of medical costs from private insurance schemes to 63 per cent of medical costs from government-funded schemes.

Their study — which scrutinised the expenses incurred by a sample of 429 patients under treatment at the Tata Memorial Centre (TMC) — is the first in the country to measure costs through the duration of treatment, which lasted over a year for some patients.

“Our results underline the need for higher caps in the insurance packages for breast cancer,” said Tabassum Wadasadawala, professor of radiation oncology at the TMC’s Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai.

For the full sample of patients, the average out-of-pocket expenditure incurred — that is, the non-medical costs plus the un-reimbursed medical costs — was Rs 186,000. It was lower for patients covered by government-funded schemes and higher for patients covered by private insurance.

Only eight per cent of the patients received full reimbursement. The study has been published in The Lancet Regional Health Southeast Asia.

The large proportion of non-medical costs appears to reflect the need for patients to travel for treatment.

About 55 per cent of the patients who had sought treatment at the TMC came from other states, mainly Bengal, Bihar and Uttar Pradesh.

The researchers found that the average medical treatment costs ranged from Rs 94,000 for patients covered by government-funded insurance to Rs 258,000 for patients covered by employee insurance schemes and Rs 336,000 for patients under private insurance.

The average reimbursement levels were Rs 59,000 (63 per cent of the medical costs) for patients covered by government-funded insurance, Rs 196,000 (76 per cent) for patients covered by employee insurance schemes, and Rs 308,000 (92 per cent) for patients with private insurance.

“The reason for such large differences in the reimbursement levels across different schemes is unclear,” said Suraj Maiti, a project scientist at the International Institute of Population Sciences (IIPS), Mumbai, and a member of the study team. “This could be a subject of future research.”

The sample of patients included 11 covered by the Centre’s Pradhan Mantri Jan Aarogya Yojana (PMJAY), a flagship scheme launched by the Narendra Modi government that offers poor households up to Rs 500,000 annually to cover hospitalisation costs.

Doctors say the treatment costs for breast cancer in other large private hospitals could be higher than those documented by the TMC study. One indicator comes from the relatively higher medical treatment costs for the richest households in the TMC sample.

“The findings suggest that the higher the patients’ ability to pay, the larger the costs they’ll incur,” Maiti said.

The other team members were Sudeep Gupta, Tejaswi Kanala, Namita Puchali, Rajiv Sarin and Vani Parmar from the TMC and Sanjay Mohanty and Soumendu Sen from the IIPS.