One part of the cancer conversation that is often neglected is how patients cope with the financial challenges of treatment.

According to the ASEAN Costs in Oncology (ACTION) study, 48 per cent of patients experience financial catastrophe 12 months after a cancer diagnosis.

Consultant breast surgeon Prof Dato’ Dr Yip Cheng Har explains that financial catastrophe is when a household has to spend 30 per cent of its income on out-of-pocket expenses for cancer care.

“In Malaysia, 45 per cent of patients experience financial catastrophe, despite the country providing universal healthcare coverage,” adds Prof Yip.

“A lot of things are not covered by government hospitals, such as expensive targeted therapy. There are also a lot of hidden costs, such as the cost of travelling to the hospital, accommodation and loss of income when patients are unable to work.”

As a result, one in five cancer patients stop their treatment due to the cost.

Karen Loh, who received treatment for cervical cancer at a government hospital, says she was forced to dig into her savings, as she did not have any insurance coverage for critical illnesses.

“These were savings that I had put aside for my children’s education, but now I had to take it out and use it for myself,” she says.

Prof Yip advises patients to start talking about the cost of treatment with their doctors right from the beginning, even at the pre-cancer stage.

It is a difficult conversation that has to be juggled with the enormity of the cancer diagnosis. The doctor’s role is not only to discuss treatment, but also to take into consideration a patient’s insurance coverage, employment and family support.

In July 2018, the Galen Centre for Health and Social Policy convened a multi-sectoral stakeholder consultation meeting on cancer, to compile key policy recommendations towards improving cancer treatment and care.

According to Galen Centre’s CEO Azrul Mohd Khalib, there is increasingly more concern about ensuring better access to life-saving, quality cancer treatments, as well as finding equitable and sustainable solutions for patients’ financial challenges.

Several issues that surfaced from the consultation included the existence of dual referral charges, where patients are charged higher fees at government hospitals if they are referred from a private hospital, as opposed to entering the government hospital from the very start.

Patients are also burdened by insufficient insurance coverage. In the case of employer-provided health insurance, patients are often limited to private care and their claims are capped at a low level.

In addition, SOCSO (Social Security Organisation) benefits are only available for Stage 4 cancer patients who have lost their jobs.

Considering that a single chemotherapy session can vary from RM100 (government hospitals) to RM400 (university hospitals) and RM5,000 (private hospitals), it is not difficult to see why patients across the socioeconomic divide fall into dire straits.

While the public healthcare system provides a safety net of universal health coverage, the reality is that the system is riddled with bureaucracy, paperwork and long waiting times.

It is time to seriously address the financial aspects of cancer care. Otherwise, the choice between survival and death might be just an illusion.

Listen to the podcast ‘Public Health #3: Surviving Cancer’:

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