Wednesday, April 11, 2012

Dialysis pricing conundrum

Should dialysis prices be high or low? A simple question like this can confound nuts like me!

As a patient, I feel pricing should be as low as possible. It is, as it is, an expensive treatment. How can ordinary people afford the treatment if the prices are too high?

However, if prices are too low, can quality really be maintained? Can people who value quality and are interested in providing quality remain in business if the prices fall too low? Yes, this may seem like a lame argument from someone who earns his living from dialysis. But think about it without being biased. It is true.

There are dialysis providers at both ends of the spectrum and many in between. The problem comes when people start expecting quality from the low priced providers and low prices from the quality providers. The unfortunate truth is both quality and low price are simply not possible together.

We must remember a simple truth. Businesses are here to make money. Whether it is the restaurant business, the movies business or the healthcare business. Everyone is there in it for the money. Despite tall pretentions of doing good, the primary motive is money. Satisfying taste buds might be a by-product. Entertaining people might be a by-product. Providing quality healthcare might be a by-product. The primary motive is to make money. Neither the providers nor the customers should ever forget that.

When it comes to charity organizations, we must remember the primary motive is not quality. The primary motive is to benefit as many people as possible. The primary intention is to reach people who need the treatment. So, you cannot expect any frills. You should be happy to get the basic dialysis treatment. Which is also all right because at least people continue to get dialysis. People, who otherwise might have died from lack of dialysis are alive because of this.

When we accept these two aspects, the rest follows easily.


pc said...

hi i am a dialysis patient from mumbai working as a senior technical trainer want to start my own business

any advise

Rich Berkowitz said...

Kamal my friend, your logic falls apart when for-profits make decisions based upon how much money they can make. On the U.e. there is no doubt quality is better at the non-profits who take in much less money. The question becomes where do they spend the money that comes in. With the for-profits, excess money, or earnings, go to top management and shareholders. That's the main purpose of the for-profits.

Management salaries are extraordinarily high -- some may argue more than anybody needs to live a good life. So the more profitable don't necessarily mean better quality.

In fact, the best outcomes are in countries where socialist healthcare is practived.

I fear you're caught in a conundrum trying to rationalize higher cost because you are now a dialysis provider owner too.

Kamal D Shah said...

Hi Rich,

I should have qualified my post by saying that this is true only in the Indian scenario. I have no knowledge of how things are in the US and other countries. But I can say for sure, from first hand knowledge that the quality of dialysis offered by most of the not-for-profit dialysis units in India is not as good as that offered in most of the for-profit centers.

Note that I say most because there are exceptions.

The primary difference between India and other countries is the payer. Who pays for dialysis? In India, it is mostly the patient himself. Out of pocket. In the US, it is mostly insurance and the government. The outcomes of socialist healthcare are the best simply because the individual does not have to pay anything. The treatment is not chosen by how much you can pay.

Here, we decide how much EPO to take and which blood tests to do based on how much we can afford.

Government schemes exist but they are based on a fixed amount of spend per patient per month. The amount covers only twice weekly sessions. I have heard horrendous accounts of how these units often cut treatment times to three hours and how one alpha EPO injection is given EVERY MONTH.

So, while I totally agree that in the US, not-for-profits might give better dialysis than for-profits, in India, it is definitely not so.

Having said that, I still appreciate greatly the work done by not-for-profits. I am involved with one of them and have volunteered my time to help them with things such as software. Without them, many patients would have died long back.