1554P - Co payments in cancer patients: Analysis and estimating OOP

Background

In India public spending on health is 1.5% of the GDP, which is far lower than most countries in the world. The poor public expenditure on health has led to mushrooming of private care, with 60% of hospitalization and 70% outpatient care being offered now by the private hospitals. Private treatment is expensive leading to OOP and catastrophic expenditure. Furthermore, insurance penetration in India is less than 20% adding to the financial woes. Those insured also have to resort to OOP for outpatient services, rehabilitation, supportive care, drugs, disposables and copayments. Copayments vary according to disease, type of policy, age of insured, drug administered, premium limit among other factors.

Methods

All adult insured patients who underwent treatment in the Department of Medical Oncology from April 1 2023 to March 31 2024 were included in the study. This is a retrospective cross sectional observational study.

Results

A total of 236 patients were included in the study comprising 79 (33.4%) males and 157 (66.6%) females. Commonest cancers were Breast (29.6%) and Lung (11%). Most patients were in the age group 41-60 (43.2%) and 61-80 (40.6%) respectively. Co payment was calculated as: amount spent by patient / total insurance approved amount x 100. Average insurance approved amount was 947 USD. Average co payment was 151 USD (16% of approved amount). 105 patients had < 1% (44.4%), while 87 patients (36.8%) had 1-20% co payment. 6.35% had more than 60% co payment expenditure. 50 patients (21.1%) had their claims completely taken care of. Classified for gender copayments amongst men vs women were 61 (77.21%) vs 125 (79.6%) respectively. 96% patients taking Immunotherapy resorted to OOP. Their copayments were almost double of the average (291 USD), while their approved amounts were less than the mean (864 USD).

Conclusions

Insurance for Cancer patients is essential to ensure access to care. Copayments lead to OOP in insured patients. In our study 78% patients had some form of copayment. While most patients had < 1% copayment, 15% had more than 60% OOP. Average copayment was 16% of the total approved amount. OOP was higher among Immunotherapy patients with lesser approved amounts. Measures to reduce copayments and OOP for insured patients is essential to maintain continuity of Cancer care.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.