Publication Type:

Journal Article


The Lancet Oncology, Lancet Publishing Group, Volume 15, Number 6, p.e223-e233 (2014)



Cancer prevention, cancer screening, cancer therapy, clinical decision making, cost of illness, Delivery of Health Care, early diagnosis, health care cost, health care delivery, health care facility, health care policy, health care quality, Health Policy, Health Services Needs and Demand, human, Humans, India, medical education, Neoplasms, patient care, personnel shortage, political participation, priority journal, program cost effectiveness, public-private partnership, review, Socioeconomic Factors, total quality management


The delivery of affordable and equitable cancer care is one of India's greatest public health challenges. Public expenditure on cancer in India remains below US®10 per person (compared with more than US®100 per person in high-income countries), and overall public expenditure on health care is still only slightly above 1% of gross domestic product. Out-of-pocket payments, which account for more than three-quarters of cancer expenditures in India, are one of the greatest threats to patients and families, and a cancer diagnosis is increasingly responsible for catastrophic expenditures that negatively affect not only the patient but also the welfare and education of several generations of their family. We explore the complex nature of cancer care systems across India, from state to government levels, and address the crucial issues of infrastructure, manpower shortages, and the pressing need to develop cross-state solutions to prevention and early detection of cancer, in addition to governance of the largely unregulated private sector and the cost of new technologies and drugs. We discuss the role of public insurance schemes, the need to develop new political mandates and authority to set priorities, the necessity to greatly improve the quality of care, and the drive to understand and deliver cost-effective cancer care programmes.


cited By 16

Cite this Research Publication

C. S. Pramesh, Badwe, R. A., Borthakur, B. B., Chandra, M., Raj, E. H., Kannan, T., Kalwar, A., Kapoor, S., Malhotra, H., Nayak, S., Rath, G. K., Sagar, T. G., Sebastian, P., Sarin, R., Shanta, V., Sharma, S. C., Shukla, S., Vijayakumar, M., Vijaykumar, D. K., Aggarwal, A., Purushotham, A., and Sullivan, R., “Delivery of affordable and equitable cancer care in India”, The Lancet Oncology, vol. 15, pp. e223-e233, 2014.