Funding better outcomes
Why we need sustainable investment in cancer care
One of the biggest challenges facing oncology is the question of how to manage rising costs and achieve financial sustainability.
The financial pressures associated with cancer are enormous – and rising, says Rifat Atun, Professor of Global Health Systems at Harvard University. “Many countries are undergoing a demographic transition,” he explains. “Which means increased longevity and an ageing population.”
As people live longer, the causes of earlier deaths are giving way to new conditions. In parallel, an epidemiological transition is under way. This means an emergence of chronic diseases, including cancer, with risk factors such as smoking and obesity also contributing to cases, alongside longevity.
A new deficit needs new money
The problem is that a transition in financing has not happened. “In many systems, funding is based on historic budgets, and it is incremental,” says Professor Atun. As a result, cancer budgets have not kept pace with the burden of cancer in terms of the lives lost and the suffering it causes. This is partly because of the speed of the demographic transitions, but also the fact that institutional systems are not robust enough.
“There is a big gap – and it is widening – between what is needed and what is provided,” Professor Atun warns. “We’re stuck in the past, and that’s a big problem.”
The first and most important consideration is ensuring adequate care: spending has to at least increase in line with the burden of the disease. Then, there is the question of where new money will come from. Sometimes it comes from new sources. So-called ‘sin taxes’, for instance, such as taxes on tobacco products, have been introduced in some parts of the world and can generate substantial revenue.
In other cases, the answer may be to use new financing instruments, such as social impact bonds. “Providers are remunerated for achieving results,” Professor Atun explains. “So, there is a real focus on improving outcomes.” While such instruments have not been deployed specifically for cancer, he says, they have been used successfully in relation to maternal and child health and for chronic problems such as hypertension.
Time for a system overhaul
Critical to the success of any funding changes will be demonstrable improvements and efficiencies in cancer care systems. “We need to transition to higher-value health systems,” says Professor Atun. “If the engine in your car doesn’t work, putting in a better grade of petrol is not going to make the car move any faster.”
The imperative for reform has only been strengthened by the devastating impact of Covid-19. A 2021 research paper on cancer care in Chile, published in The Lancet Oncology, examined the impact of delays on diagnosis and referral. The findings suggest a 15% increase in mortality because of Covid-19’s disruption of that part of the system alone, not accounting for other disruption such as the effects on treatment regimens. Oncologists have warned of an oncoming tsunami of cancer cases.
Ultimately, the key to rethinking how cancer is financed could be to focus on early intervention. Investment in high-value interventions, such as prevention, screening and early diagnosis, reduces downstream costs, while reducing the incidence of illness supports economic productivity.
“We should stop thinking about health as being an expenditure or a burden,” says Professor Atun. “It’s one of the best investments we can make.”