Universal health coverage to address the financial costs of cancer
Financial Cost of Cancer
A commitment to achieving Universal Health Coverage (UHC) in Australia would greatly address the financial costs of cancer. UHC means that all people have access to the health services they need, where and when they need them, without facing financial hardship.1 A well-funded and functioning universal healthcare system, social security system and other social protections are necessary for Australia to reach its commitments to achieve UHC. UHC includes the provision of health protection and promotion services, as well as disease prevention, treatment, rehabilitation, and palliative care.
UHC has three main goals and a key focus on equity, marginalised communities and fair access to healthcare.1
Figure 1. The goals of Universal Health Coverage.
Australia has made several commitments to UHC which is considered to be the practical expression of the right to health, including under the International Covenant on Economic, Social and Cultural Rights.2 Australia has committed to achieving UHC by 2030 under Target 3.8 of the Sustainable Development Goals and the 2019 United Nations Political Declaration on UHC.3 UHC is highly relevant to reducing the costs of cancer in Australia. Australia approaches UHC through a range of different laws and policies, including those that established Medicare, the Pharmaceutical Benefits Scheme, national cancer screening programs, National Immunisation Program, and the private health system.4
Australia has a well-developed universal healthcare and universal health coverage framework, that broadly meets the goals of UHC (i.e., population coverage, equity of access, quality healthcare services, financial risk protection). However, whether Australia is maintaining these goals is questionable, given the significant inequities in access to healthcare, service quality and financial risk protection.5, 6 There has been an erosion of UHC in Australia through gaps in Medicare coverage; increasing out of pocket costs for access to health services, diagnostics and medicines; and fragmentation of cancer prevention and care services and shortcomings in social support systems, such as social security.7, 8
Definitions
Financial burden
A term used to describe the financial problems a person has related to the cost of healthcare. People affected by cancer are more likely to have financial burden than people not affected by cancer.
Financial toxicity
The negative patient-level impact of the cost of cancer. It is the combined impact of direct out-of-pocket costs of treatment and indirect costs, causing both physical and psychological harms, affecting decisions which can lead to suboptimal cancer outcomes.9 Financial toxicity combines the objective financial burden with the subjective financial distress experienced as a result of a cancer diagnosis.10
People with cancer
Individuals who have or have had a cancer diagnosis, and/or have undertaken cancer treatment and/or services.
People affected by cancer.
Those people and relationships with the person with cancer that may be impacted by the cancer diagnosis, such as family, social networks, the workforce and the broader community. With that in mind, the term, ‘people affected by cancer’ usually refers to a person with cancer and their immediate family, carers and friends.
Cancer Survivor
An individual is considered a cancer survivor from the time of diagnosis through the balance of life. There are many types of survivors, including those living with cancer and those free of cancer. This term is meant to capture a population of those with a history of cancer rather than to provide a label that may or may not resonate with individuals.11
References
- World Health Organization. Universal health coverage: WHO, ; 2022 [Available from: https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)]
- Attorney-General's Department. Right to health Canberra (AU): Australian Government 2023 [Available from: https://www.ag.gov.au/rights-and-protections/human-rights-and-anti-discrimination/human-rights-scrutiny/public-sector-guidance-sheets/right-health]
- Political declaration of the high-level meeting on universal health coverage, (2019).
- Department of Health and Aged Care. The australian health system Canberra (AU): Australian Government; 2023 [Available from: https://www.health.gov.au/about-us/the-australian-health-system]
- Feletto E, Grogan P, Vassallo A, Canfell K. Cancer costs and gender: A snapshot of issues, trends, and opportunities to reduce inequities using australia as an example. Climacteric. 2019;22(6):538-43.
- Fitch MI, Sharp L, Hanly P, Longo CJ. Experiencing financial toxicity associated with cancer in publicly funded healthcare systems: A systematic review of qualitative studies. Journal of Cancer Survivorship. 2022;16(2):314-28.
- Banatvala N, Banatvala N, Bovet P. Noncommunicable diseases a compendium: Taylor & Francis; 2023.
- Union for International Cancer Control, Cancer Council Australia. Addressing cancer control within universal health coverage. Geneva (CH); n.d. https://www.uicc.org/sites/default/files/atoms/files/UICC_Report_Universal-Health%20Coverage_FA.pdf
- Varlow M, Bass M, Chan RJ, Goldsbury D, Gordon L, Hobbs K, et al. Financial toxicity in cancer care Clinical Oncology Society of Australia; 2022. https://cosa.org.au/media/q3ohepgs/financial-toxicity-in-cancer-care-7.pdf
- Zafar SY, Abernethy AP. Financial toxicity, part i: A new name for a growing problem. Oncology (Williston Park). 2013;27(2):80-149.
- National Cancer Institute. Survivorship terms, adapted from the national coalition for cancer survivorship. 2022. https://cancercontrol.cancer.gov/ocs/definitions