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Kidney dialysis unavailable to seventy percent

Seventy percent of patients requiring kidney dialysis in India don’t receive it according to a new study published in The Lancet. The cause of this deficit is a combination of both unavailability and unaffordability.

An estimated 200,000 new patients require dialysis treatment a year, with kidney diseases becoming one of the highest causes of mortality in India over the last decade.

Of prime concern to many is the cost of dialysis. Around 70 percent of Indians live below the international poverty line, earning Rs 45 or less per day. As dialysis treatment is typically a regular occurrence, usually multiple times per week, this automatically disqualifies nearly three quarters of the population from treatment. Studies place the average cost of dialysis at Rs 150 in government hospitals, with private hospitals significantly higher at Rs 2000.

Though this pricing system puts dialysis out of the reach of many, India’s kidney dialysis costs are at a significantly lower price range compared to other nations. In a private hospital, dialysis over the course of a year will cost on average Rs 140,000, equivalent to around $3,000 USD. Compared to average yearly costs of around $60,000 USD in the US and UK this seems a more reasonable fee. Despite the lower costs, 90 percent of Indians could not afford this sum.

Professor Vivekanand Jha, Executive Director of the George Institute for Global Health; the lead author of the paper, says that “As we in India embark on an ambitious national dialysis control program, we must ensure that minimum standards of quality and safety are established for dialysis units and regulations introduced where necessary to ensure standards are maintained,”

The paper headed by Professor Jha establishes that Indian health systems should emphasise prevention of kidney disease while also improving dialysis and transplantation programmes. Another key aim is the reduction of costs of dialysis, while maintaining standards of quality.

While this may improve service to areas that already have access to dialysis services, another major issue discussed within the paper is access to this service and “distributive justice”. Geospatial analysis studies have shown that 60 percent of Indians live more than 50km away from a healthcare facility that provides dialysis treatment. For many already struggling to pay for the dialysis the extra cost of both the transportation and lost working hours may again make dialysis an impossibility.

The study lays out a framework health policy, providing recommendations hoping to shape health policy and guide healthcare practice. It establishes the ethical challenges faced in the provision of dialysis treatment that it describes as previously being rarely discussed. Further investigation is needed into India’s emerging, and rapidly growing problem of kidney disease.

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