Palliative care, a way to reduce financial distress for people with life limiting diseases  Premium

Non-communicable diseases are pushing more people into poverty due to the financial burden of treatment. Palliative care can reduce healthcare expenditure by up to 25%, yet awareness and access to such care is low. The National Program for Palliative Care needs reorganised funding and increased awareness to help protect people from avoidable health expenditures. Investing in palliative care is a win-win situation for patients, families, and healthcare providers. It is time public and private healthcare providers prioritise palliative care.

“I couldn’t go for my six-monthly check-ups at the government district hospital as I didn’t have the money for the autorickshaw. The travel alone costs around ₹1,200. My monthly income is only ₹1,600 through my disability pension. How can you expect me to go to the hospital? Where will the money for my routine expenditure come from?” asked Shankar (name changed), a 55-year-old man from Kerala who had been homebound for the past two years due to a stroke.

Like Shankar, many Indians are either a hospital bill away from poverty or too poor to access healthcare. It is estimated that nearly 5.5 crore people fall below the poverty line every year due to out-of-pocket healthcare expenditure. Out of these, 3.8 crore people become poor only because of the expenditure on medicines. “India is becoming the epicentre for non-communicable diseases and several of the patients with these diseases, like cancer, cardiac disease, renal failure or stroke, will eventually reach an incurable stage,” says Padma Shri and 2023 Magsaysay Award recipient Dr. Ravi Kannan.

Non-communicable diseases will push more and more people into poverty as they require lifelong treatment and periodic health check-ups. However, the financial implications for a family associated with the continuous treatment of these diseases often go unnoticed in our health system. This often leads to ‘financial toxicity’ wherein there is a risk of bankruptcy, decreased treatment satisfaction, foregoing or delays in seeking further medical care, poor quality of life, and poor survival.

With only 1.35% of the gross domestic product (GDP) being spent on government health services, patients bear most of the health expenses. Even in government hospitals where treatment is supposed to be free, the cost of travel, purchasing medicines that many a time are out of stock in government pharmacies, and loss of wages due to the absence from work contribute to the financial toxicity.

A recent study by Dr. Prinja and his colleagues from India reported that an average of ₹8,035 is spent by a cancer patient per outpatient visit and ₹39,085 per hospitalisation in a tertiary care hospital in India. Similarly, the cost per outpatient clinic visit in a tertiary care hospital is ₹4,381 for a patient with diabetes and ₹1,427 for a patient with hypertension. Towards the end of life, attempts to continue treatment with the aim of prolonging life leads to even more financial burdens. Often caregivers have to sell assets and stop the education of children in the family to cope with the financial burden. The same study also reported that in patients with last-stage cancer, more than 65% faced impoverishment due to healthcare expenditure.

Palliative care is a branch of medicine that looks at improving the quality of life of those having life-limiting illnesses like cancers, end-stage kidney disease, debilitating brain disorders, complications of diabetes, and heart disease among others. It is different from other medical specialities as it focuses on alleviating uncontrolled symptoms of the incurable illnesses mentioned above, and preventing non-beneficial investigations, and treatments. It takes into consideration not just the physical dimension of health but also actively looks at the social and economic realities of the patient and the family.

Early initiation of palliative care in patients with advanced disease has shown to reduce health expenditure by up to 25%. Palliative care is provided through outpatient visits, inpatient visits, and home-based care. Home-based care further reduces the cost of seeking care as home-bound patients no longer have to travel to seek healthcare. Vocational rehabilitation and social reintegration are crucial elements of palliative care which further help the affected family and the patient by providing them with the opportunities to earn a living and live independently with dignity. “Depending on their ability to work, we provide rehabilitation support to patients. We either teach them basic skills like stitching or introduce them to small-scale animal husbandry so they can have a source of income,” told John, a social officer at Pallium India.