Table 6

Cancer health services in Asia by per capita gross national income (GNI, 2012) categories
Income category Countries (N = 48) Cancer health services and infrastructure
Low-income countries (per capita GNI < US$1,036 ) Afghanistan, Bangladesh, Cambodia, Democratic Republic of Korea, Kyrgyzstan Republic, Myanmar, Nepal, Tajikistan Poorly developed healthcare infrastructure and overextended services far exceeding capacity, limited human resources, poorly supported by government financial resources. Healthcare financing is mostly by catastrophic out-of-pocket expenditure. The level of development and planned annual vertical investments by governments in infrastructure and in terms of financial and human resources fall far short of the level to ensure equitable access to preventive, diagnostic, treatment and follow-up care for the general population. More than three-quarters of patients with cancer do not receive adequate care, with poor survival prospects. Some countries such as Bangladesh are working towards universal health coverage.
Lower-middle-income countries (per capita GNI US$1,036 to US$4,085) Armenia, Bhutan, India, Indonesia, Laos, Mongolia, Pakistan, Philippines, Sri Lanka, Syria, Timor-Leste, Uzbekistan, Vietnam, Yemen, West Bank and Gaza Cancer health systems are fragmented and mostly centred in urban areas, with underinvestment in equipment, essential consumables and drugs and human resources development; vast regional variation of services within countries exists, with extremely limited availability of and access to care for rural and socioeconomically disadvantaged populations. Some countries such as India, Indonesia, Philippines, Sri Lanka and Vietnam are working towards universal health coverage.
Higher-middle-income countries (per capita GNI US$4,086 to US$12,615) Azerbaijan, China, Georgia, Iran, Iraq, Jordan, Kazakhstan, Lebanon, Malaysia, Maldives, Thailand, Turkey, Turkmenistan Cancer health systems are still evolving with less integrated multiple independent systems of care; considerable potential for further improvements in infrastructure, coverage and healthcare financing in most countries. Rural areas have inadequate services in large countries such as China. Some countries such as Thailand, Malaysia and Turkey have much better facilities and systems developed with universal health coverage providing seamless access for prevention, early detection and satisfactory clinical management of common cancers and improved survival outcomes.
High-income countries/regions (per capita GNI > US$12,616) Bahrain, Brunei Darussalam, Hong Kong SAR of China, Israel, Japan, Republic of Korea, Kuwait, Macao SAR of China, Oman, Qatar, Saudi Arabia, Singapore, Taiwan, United Arab Emirates High government investment in well organised healthcare infrastructure, well resourced and highly accessible diagnostic and treatment services, facilities exist for early detection, advanced state-of-the-art diagnostic and treatment services within public health services, expatriates contribute to a high proportion of human resources (healthcare providers) in West Asian high-income countries.

Sources: adapted from World Bank (http://www.worldbank.org/ webcite)/Sankaranarayanan et al. [20]/United Nations [23].

Sankaranarayanan et al.

Sankaranarayanan et al. BMC Medicine 2014 12:3   doi:10.1186/1741-7015-12-3

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