17- October-2023-Special-Article

PALLIATIVE CARE

What is Palliative Care?

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. Early initiation of palliative care in patients with advanced disease has shown to reduce health expenditure by up to 25%.

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.

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.

“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”.

Miniscule share of the govt.

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.

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.

Lack of investment in palliative care

Despite existing for nearly four decades, awareness regarding palliative care in India, both among healthcare workers and the general public is low.

Also, currently, palliative care is not covered under most insurance schemes in India. Unplanned and abysmal funding has also been a barrier to public health centres providing palliative care services.

The palliative care is included in the ambitious Ayushman Bharat program.

Incorporating palliative care into the Indian healthcare system

The funding mechanism of the National Program for Palliative Care needs to be reorganised. Under the current mode, the state government is not sure whether the money will continue to be available in the subsequent year. This prevents long-term planning.

Palliative care provisions will help in generating goodwill for corporate hospitals. “The family of the patient who has been taken care of at the end of their life will remain eternally grateful to the caregivers.

It is the moral obligation of the health system to take care of people, especially when they are suffering from life-long and life-limiting illnesses. It’s high time public and private healthcare providers realised the high returns of investing in palliative care and prioritised it.

Palliative treatment in India

According to a recent survey, more than 108 entities currently provide facilities to improve the quality of life and palliative treatment services in 16 states/union territories.

These are mainly restricted to major cities and regional cancer centers, with the exception of Kerala, where services are more readily available than in other states. NGOs, public and private hospitals, and hospices are primary care providers.

Services have developed unevenly, with the south having more services than the north. The majority of states have subpar coverage. Palliative care is hardly used in 19 states or union territories

Mains Questions

1. Palliative Care is the most financially draining stage for many families. In this backdrop, highlight the issues related to Palliative Care in India? (150 Words) 10 M