Most people pay for their own medical treatment in India, kidney related or otherwise. Only people working for the government or large corporations have their medical expenses covered. While this is all right for minor problems that are transient, it can be a lifelong nightmare for chronic conditions.
The cost of one session of hemodialysis is about Rs. 1,200 when the dialyzer and tubings are reused. When a new set is used, it can be about Rs 2,000. This is probably the average cost across India. It could be higher in places like Mumbai and lower in the smaller cities. For someone who does three sessions per week which is the bare minimum, the cost comes to about Rs. 15,000 per month. Add to this, the cost of Erythropoetin, lab tests, doctor consultations and other medicines. The total cost of treatment, then, is atleast, about Rs. 25,000 per month. Friends in the US, please do not convert to dollars and say that is quite cheap. Indians earn in Rupees, remember?
The average Indian cannot afford this expense. I personally know many people who had to undergo the agony of knowing that a treatment is available but they did not have the money to pay for it. Or people who had enough money only for one or two treatments per week. They would come in for dialysis in a terrible shape, totally breathless because of the fluid build-up. Inevitably, you would stop seeing them after a few months.
My gut wrenches when I think of these people. That's when I think - why do we need to send a rocket to the moon when we have thousands of people dying because of the lack of money to be able to afford a life-saving treatment. And we are talking about in-center hemodialysis which is only 'adequate', far from 'optimal'. Will we ever reach a stage when we start talking about optimal dialysis for everyone when we are far, far away from even adequate dialysis?
The problems in India are very different from those in countries like the US. The large population means an even greater number of people needing dialysis. The government does provide free dialysis in hospitals run by the state. But these units leave a lot to be desired. The number of sessions available are also much less than what is required. Government programs like Arogyasree are definitely a step in the right direction. The more I think about it, the more I wonder about how on earth this came about. Whoever conceptualized this really needs to be commended.
In the US, as I mentioned in the first of these posts, there is a lot of discussion going on about optimal dialysis and the measure of good dialysis. They say Kt/V is not a good measure. I have been on dialysis for more than 11 years and I have not had my Kt/V measured even once on hemo. A discussion on whether that measure is good enough or not is moot. Truly, things are very different here.
Here the priority is providing minimal dialysis to everyone that requires it - to save lives. The priority is really not optimal dialysis.