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Summary

Cancer is now the second most common cause of death in high income countries (HIC) and is a rapidly growing concern in low and middle-income countries (LMIC). To shape and inform the policy dialogue around public financing for countries’ efforts to improve cancer control, ThinkWell conducted a landscape review on how health systems can more sustainably and equitably leverage public sector resources to provide comprehensive and high-quality oncology care, including access to new technologies and therapies. This review resulted in six country studies and a global summary. These six country studies draw on the expertise of country health system experts and local stakeholders, bringing together new evidence and fresh perspectives on the state of oncology financing from experience around the globe.

This project is supported with funding from Merck & Co., Inc.

Challenges

Cancer is a growing contributor to the disease burden globally, with cases projected to increase as populations age and average life expectancy increases. In HIC, the “silver tsunami of cancer,” a phrase coined by researchers in the United States, is a poignant metaphor for the challenges that many health systems will face in terms of managing higher caseloads and the health needs of survivors, many of whom will have co-morbidities, making their care both more complex and costly. In LMIC, and even in some HIC, access to care and treatment are often highly determined by a patient’s wealth or place of residence, leading to significant disparities in access and cancer outcomes. Countries of all income levels grapple with how to finance access to new and innovative – and often expensive – cancer therapies while ensuring sufficient funding for prevention programs, integrated care models, and palliative/rehabilitative care.

The oncology continuum is complex, involving a wide set of public sector actors, all of whom directly or indirectly influence the patient experience. From targeted prevention strategies focusing on high-risk behaviors, to targeted therapies by cancer type, public financing and the flow of funds for oncology influence how effectively, efficiently, and equitably cancer interventions reach patients in need or populations at risk. On the one hand, many low-cost, high-impact public health measures to prevent cancer are underutilized and underfunded, while on the other hand, new breakthroughs in cancer therapies are extending survival and quality of life, both during and post-treatment.

Approach

To better understand how countries finance the oncology continuum, ThinkWell, with on-the-ground support from local health financing and health system research experts, analyzed how public funding influences the performance of the oncology continuum from prevention, diagnosis, and treatment to palliative care and rehabilitation.

In reviewing current evidence and gathering insights from local experts and key stakeholders, we aimed to identify the various financing drivers influencing a country’s oncology continuum program, and develop policy options that can help to overcome the financing challenges in the system. We analyzed trends in public funding for cancer and when possible, estimated public cancer expenditures to understand the breadth and depth of public investment in oncology.

This oncology financing landscape resulted in six country profiles that showcase how countries are confronting health system challenges in oncology and what more can be done in the oncology policy and financing environment to increase access and improve cancer outcomes.

Breaking New Ground

This project is unique as it presents a comprehensive review of sustainable health financing from an oncology perspective. The project moves beyond the understanding of current situations at the micro-level to a synthesis of key factors on the macro-level, such as the state of the health financing in general, and how public financing impacts the oncology care continuum.

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