New Delhi, Mar 15: India’s flagship health insurance programme, Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, has emerged as a lifeline for cancer patients, offering financial protection and timely access to care that would otherwise be out of reach for most of them, even as a huge gap still exists in annual allocation and requirement, a recently released study said.
The FinCan study, conducted by oncologists and health economists led by Dr Abhishek Shankar, Assistant Professor, Department of Radiation Oncology, DRBRAIRCH (Dr B R Ambedkar Institute Rotary Cancer Hospital) under AIIMS (All India Institute of Medical Sciences) Delhi, provided fresh insights into the programme’s strengths and pointed out opportunities to supercharge its impact.
The AB-PMJAY has undeniably improved access to oncology treatments, the authors said.
According to government data, the scheme has helped cover over 68 lakh cancer treatments worth around Rs 13,000 crore since its inception in 2018, especially benefiting rural and low-income populations.
Targeted therapies accounted for a significant share of that outreach, a crucial advance in modern cancer care.
A study published in The Lancet found that enrolment under AB-PMJAY raised the likelihood of initiating cancer treatment within 30 days of diagnosis by about 90 per cent compared to pre-2018 levels.
The FinCan study demonstrated that delivering the full five-year Standard of Care for cancer — including diagnostics, surgery, targeted drugs, radiotherapy and follow-up — would require an estimated Rs 33,000 crore annually.
The AB-PMJAY currently allocates only about Rs 7,700 crore per year for cancer under its existing package structure, indicating that a huge gap still exists in spite of reducing the access issues to a larger extent.
Dr Shankar, who led the FinCan Study, said, “Better cancer care is not only about spending more but also about spending smarter, especially where early diagnosis and well-designed coverage can prevent both late-stage suffering and catastrophic costs.” FinCan models showed that expediting diagnosis and treatment initiation will save about Rs 1,500 crore annually and translate into 1,560 additional survivors per year.
An annual saving of Rs 5,000 crore, with over 30,000 additional lives saved each year, was projected in early detection through screening aligned with Organisation for Economic Co-operation and Development (OECD) benchmarks.
Policy recommendations that emerged from the study focused on restructuring AB-PMJAY to better reflect cancer’s real-world cost profile.
A proposed reform was a five-year “revolving ceiling” of Rs 25 lakh per family, replacing the current Rs 5 lakh annual cap. This approach would allow patients to use more funds in high-cost years — like the first year of treatment — and less later, ensuring continuity of care without financial interruption.
Additionally, the study supported a Rs 10 lakh top-up for high-stage cancers, targeting about 30-37 per cent of patients who require particularly expensive treatment, while allowing early-stage cases to be self-sustaining under the revolving ceiling.
To maximise the benefits of early detection, the study also recommended embedding diagnostic coverage and screening support into the scheme. Diagnostics currently account for just 3 per cent of total cancer care costs, yet they often fall outside AB-PMJAY and delay access to treatment.
Integrating screening and diagnostics via Health and Wellness Centres under the National Health Mission or incorporating them into AB-PMJAY packages could both save lives and reduce costs, the study recommended.
India’s policymakers have already taken steps in this direction, Dr Shankar said.
The 2025-26 Union Budget earmarked funds to set up 200 new day care cancer centres in district hospitals, aiming to expand access and reduce out-of-pocket expenses. Customs duties on several lifesaving cancer drugs were also cut or exempted, helping reduce medicine costs, he said.
In summary, AB-PMJAY has undeniably expanded access to cancer treatment, accelerated treatment initiation, and lessened some financial strain. However, the FinCan study said, there is untapped potential in strengthening early detection, redesigning benefit ceilings, and embedding diagnostic and long-term follow-up care into the scheme.
Through “spending smarter”, Dr Shankar said, India can not only save lives but also reduce the economic burden of cancer on households, reinforcing AB-PMJAY’s role in delivering Universal Health Coverage. (PTI)
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