For many in countries like the USA, where healthcare costs are prohibitive, India is emerging as an attractive destination to get the necessary treatment as it has some of the world’s cheapest hospitals. Yet, for Indians, most of these are still out of reach, and an estimated 37 million people slip into poverty each year, after paying the hospital bills out of their pockets. With chronic diseases like diabetes on the rise in India, many are admitted to hospitals and undergo expensive procedures, like haemodialysis, to manage their health. A recent study, by a team of international researchers, has examined the cost burden of haemodialysis and found that about nine in ten households found it hard to meet the expenses, in spite of some availing subsidies.
In India, about 17% suffer from chronic kidney diseases, some of which result in kidney failure, also called end-stage renal disease (ESRD). In such cases, haemodialysis is a procedure used to remove waste products and filter the blood—a function otherwise performed by the kidneys. This procedure incurs an overall cost of about INR 4148 per session in a public tertiary hospital—an amount roughly half the average monthly income in India.
In the current study, the researchers have surveyed 835 patients in 15 haemodialysis facilities in the state of Kerala to assess whether availing subsidies resulted in lowering the financial burden on these families due to hospital costs. “It is the first multicenter description of the financial hardship experienced by patients on hemodialysis in a resource-constrained setting”, say the researchers about the study. It was funded partially by the Wellcome Trust-DBT India Alliance and was published in the journal Kidney International Reports.
The researchers chose the state of Kerala as it “represents a best-case scenario for persons on dialysis in India”. It is India’s highest performing state on overall health indices, and the state government provides subsidies to public and private hospitals for dialysis costs to those with kidney failure irrespective of their financial status. With an interview questionnaire, they collected information on the estimated monthly costs associated with the treatment, medicines, laboratory fees, travel and loss in wages of the patients and their caregivers.
The study found that about 91% of the households experienced catastrophic health expenditure, where they spent almost half of their non-food expenses out-of-pocket on dialysis-related costs. About 77% of the respondents said they borrowed from family and friends, sold their possessions or availed loans to meet the expenses. Interestingly, those families that availed government subsidies fared no better than those that did not.
“We found that indirect costs of travel or loss of employment accounted for more than one-half of monthly dialysis-related expenses”, say the authors.
Besides, 7 in 10 patients with private insurance still experienced catastrophic health expenditure, perhaps because most of them get treated by expensive private facilities, where the cost of thrice-weekly dialysis is substantial. Although additional metrics on the dialysis water quality, staffing, infections and mortality are needed to justify this higher cost, the researchers opine that if government institutions can provide similar-quality care at lower prices, the overall financial burden of haemodialysis therapy could be substantially reduced.
Apart from providing subsidies, which is clearly not working in easing out the financial burden of the patients, the researchers suggest other measures that can help in this regard. Early detection and prevention of chronic diseases and risk factors, programs to build and maintain organs of the deceased for kidney transplants, the inclusion of dialysis therapy in universal healthcare packages and insurance schemes that help patients to pool resources for future medical expenses can help, they conclude.