International Health Systems

Much of what contributes to cancer survivorship depends upon the health care system and the economic environment within which the individual must interact.16 Health care systems vary tremendously among nations, as does the economic infrastructure of the nations themselves.16

In Europe, most countries do not attach health insurance to employment; therefore, losing a job does not mean the individual loses their health insurance. The removal of the economic threat of losing health insurance for ongoing care needs, and the provision of quality care for both the rich and the poor, at minimal or no cost, is a goal of the health care systems in the United Kingdom, Germany, France, Denmark, and Norway.14 Conversely, nations without such economic resources and organized health care are in weaker positions to address cancer survivorship and all the medical and psychosocial issues it entails.14

On the other hand, India is trying to reduce the burden of those with cancer by offering a cancer insurance plan17; this plan covers the cost of treatment and ongoing care, but the individual must have purchased the plan prior to diagnosis. Also, all treatment needs to take place in India and must be conventional-based medicine, not complementary in nature. The insurance plan that may be purchased varies in the amount of coverage one wishes to establish for one's self. Table 2 below outlines the coverage under this plan based on the desired level of coverage. If the person is subsequently diagnosed with cancer, the individual is allowed reimbursement of expenses for treatment, hospitalization, and testing related to his or her condition, up to the insured amount. An individual is also able to take a one-time lump sum payment. Once the individual has cancer, he or she is allowed a renewal annual benefit as long as the policy's annual premium is paid; India's Cancer Patients and Aid Association, a charitable nongovernmental organization (NGO), has intervened to ensure this limit is renewed to handle ongoing needs, as well as helping to pay premiums to prohibit any lapse in policy coverage.17

In sum, a country's health system's organization and availability of health professionals with adequate equipment is fundamental to ongoing care however actual comparisons of these factors and actual survivorship among various cancers and across nations and systems of care require careful investigation.

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