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Kolkata: Getting insurance companies to pay -- and pay sufficiently so that patients do not suffer a hole in their pocket for medical treatment -- even after paying hefty premiums year after year, is one of the big financial concerns of the common Indian. In a recent survey report, it has come to light that insurance companies generally pay approximately 70% of claims related to cancer treatments, which leaves a gap of about Rs 4-5 lakhs, which poses a financial challenge for most of the patient parties.
The report titled 'Cost of Cancer report' composed by insurance-tech company Plum was done after analysing 8,102 insurance claims of different insurance companies. It has found that in three years, claim deductions have jumped by 58%. What is most significant is that almost 30% of the bill generated by a hospital for a cancer patients has to be borne by the patient party -- patients had to cough up Rs 23.2 crore against Rs 78 crore paid by insurance companies. The report has stated a frightening piece of statistic -- if a patient has insured himself/herself for Rs 10 lakh, he/she might end up paying Rs 4–5 lakh from his/her pocket. The reason: exclusions applicable to modern drugs and sub-limits of treatments.
The report has also flagged systemic flaws in policy design. It has mentioned that off-label drugs which are frequently used in modern cancer care are excluded from average. There is a 50% sub-limits on oral chemotherapy and advanced treatments. Furthermore, there are restrictive clauses such as room rent caps, waiting periods, and mandatory co-pays. As a result, the worst situation often takes place -- cancers which need the highest treatment costs often get the lowest payouts.
The study has found out that one in 4.7 patients go past the Rs 5 lakh insurance coverage limit. About 39.5% of cancer patients fall within Rs 1.25 lakh in treatment expenditure. And the cost of treatment for about 21.4% goes above Rs 5 lakhs.
Fortunately, early detection of cancer has gone up by 72% over the past three years. Breast cancer leads in number followed by blood cancers, colorectal cancer and lung cancer. Blood cancer and brain cancer consistently torment the highest share of patients in the cost bracket of Rs 10 lakh and more. So do liver and pancreatic cancers. Colorectal, brain and stomach cancers are the most expensive. On the other hand, stomach and ovarian cancers demand frequent medical engagement.
