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India’s public health insurance programme, Ayushman Bharat PM-JAY, was designed with a clear promise: to expand access to quality care for those who need it most. In cancer care, where timely treatment can determine survival, that promise carries even greater weight. A recent interpretation in certain quarters regarding eligibility norms for cancer specialists under the scheme has, however, raised important questions. The issue is not about intent; it is about ensuring alignment with ground realities.
At the centre of the discussion is a requirement set out by several state health authorities (SHAs) mandating that only oncologists with specific super-speciality degrees recognized by the regulator are eligible to treat PM-JAY patients. While this appears to be a move toward higher standards, it may overlook decades of medical history in India. To address a chronic shortage of formal super-speciality seats, our national pillars of clinical excellence—including Tata Memorial Hospital, AIIMS, and RCC Trivandrum—developed structured, rigorous fellowship-based training. These specialists now constitute a significant portion of the oncology workforce, leading departments and mentoring the next generation.
The first concern is access, and the realization of health equity for the last mile. India already faces a staggering shortage of cancer specialists, a gap that is most visible outside our metropolitan centres.
In many Tier-2 and Tier-3 locations, fellowship-trained oncologists—often trained at the national pillars of clinical excellence—are the primary providers of care. If they are suddenly restricted from participating in PM-JAY, the unintended result could be a concentration of expertise in urban hubs, creating a care vacuum in remote areas.
For a patient in a distant village, the technical nomenclature of a degree matters less than the presence of a skilled hand that can deliver treatment locally.
The second issue relates to regional equity, and the stability of our healthcare networks. PM-JAY is meant for economically vulnerable populations who often rely on nearby facilities integrated into the scheme. If certain experienced specialists in these facilities are no longer eligible to treat PM-JAY patients, the burden inevitably shifts to a much smaller pool of specialists in larger cities. This could create uneven access where urban centres may cope, but smaller towns struggle to maintain the continuity of care their residents deserve.
A third concern involves operational feasibility and strategic human capital utilization. Many hospitals participate in PM-JAY to serve a wide patient base, and their ability to do so effectively depends on the availability of eligible specialists. If these institutions must abruptly reorganize their clinical teams to meet new criteria, it may affect the delivery of complex treatments. In an era increasingly defined by digital health and distributed networks, where expertise is shared across geographies to reach the patient where they reside, our policies must aim to support, rather than complicate, the decentralized delivery of care. This is not a question of willingness, but of the practical capacity to serve patients without disruption.
At the same time, it is important to recognize the rationale behind the rule. Standardized qualifications can help maintain a baseline of quality and facilitate regulation across a diverse country. Institutions such as the National Medical Commission (NMC) and the National Health Authority (NHA) have the responsibility to ensure patient safety, which is especially significant in a complex field like oncology. The challenge is not whether standards are needed, but how they are applied. A uniform rule may not always capture the diversity of training pathways where fellowship programmes at reputed centres often offer more practical, hands-on exposure than formal degree courses.A broader lesson here involves policy transitions and coordination between governing bodies. When medical education and health financing policies do not fully align, gaps emerge that create uncertainty for both the practitioner and the patient. A phased approach, with clear timelines and transitional provisions, can reduce such disruption, particularly in sectors where human resources are already limited.
What might a more balanced approach look like?
First, there is a case for recognizing equivalence where fellowship-trained oncologists from accredited institutions are assessed through defined criteria such as years of experience and clinical outcomes.
Second, a “grandfathering” provision should be considered, allowing experienced doctors with clean records to continue serving PM-JAY patients while new entrants align with updated norms.
Third, India could explore competency-based assessments, similar to the United Kingdom’s Certificate of Eligibility for Specialist Registration (CESR), to recognize practical excellence in high-need areas.
Fourth, closer coordination between regulatory and implementing bodies is vital to ensure that decisions in one domain do not create challenges in another.
Finally, any policy change must be reviewed through the lens of regional equity, ensuring that smaller cities and districts are not disproportionately affected.
India’s cancer burden is rising, with a projected 17.5 lakh new cases annually by 2030. Meeting this demand will require both quality and scale, and our policies must strike a balance that makes the best use of every available unit of specialist expertise.
The current debate offers an opportunity to align policy with practice and keep the focus on patient care. When rules are aligned with reality, they strengthen the system. The task now is to bridge that gap with care and clarity, ensuring every Indian has access to the specialist care they need, regardless of their geography or income.
The article is written by Dr. Paul Sebastian, senior cancer surgeon and M. Biswanath Sinha, policy analyst. Both authors are associated with Karkinos Healthcare, a technology-led, oncology platform enabling discovery through delivery of care.
(DISCLAIMER: The views expressed are solely of the author and ETHealthworld.com does not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person/organisation directly or indirectly)
