Universal health coverage and chronic kidney disease in India

• Published in: Bulletin of the World Health Organization 2018-07, Vol.96 (7), p.442-442
• Main Authors: Essue, Beverley M, Jha, Vivekanand, John, Oommen, Knight, John, Jan, Stephen
• Format: Article
• Language: English
• Subjects: Care and treatment; Chronic kidney failure; Costs; Evaluation; Expenditures; Health care access; Health care expenditures; Health care reform; Health Care Reform - economics; Health Care Reform - organization & administration; Health Services Accessibility - economics; Hemodialysis; Home Care Services - organization & administration; Humans; India; Kidney diseases; Low income groups; Management; Medical personnel; National health insurance; National Health Programs - organization & administration; Peritoneal dialysis; Peritoneal Dialysis - economics; Peritoneal Dialysis - methods; Public health; Renal Dialysis - economics; Renal Dialysis - methods; Renal Insufficiency, Chronic - therapy; Transplants & implants; Universal Health Insurance - economics; Universal Health Insurance - organization & administration
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.18.208207

Despite receiving highly subsidized treatment, dialysis patients receiving care in these two sites in northern India still faced high medical out-of-pocket costs: 87.1% of patients in public hospitals were spending over 100% of their monthly income on dialysis compared to 78.9% of patients in private care.4 This expenditure excluded non-medical costs, which can also be substantial.5 As part of its agenda to achieve universal health coverage (UHC) by 2022, the Indian government has committed to establishing at least one eight-station dialysis unit in each of its 688 districts, and is offering free haemodialysis to people living below the poverty threshold.6 The government's ability to meet this commitment will depend not only on increasing its fiscal capacity, but also on the implementation of frugal innovations (such as low-cost dialysis machines7 and greater use of non-physician health workers), enhanced early screening interventions8 and better access to home-based peritoneal dialysis. Better access to peritoneal dialysis would potentially mitigate the substantial non-medical costs associated with travel and lost productivity to attend haemodialysis units.5'6 While financing reforms to implement UHC are critical to enhancing financial protection of patients with chronic kidney disease, these reforms are not enough. Dialysis and transplantation are highly unaffordable in most low- and middle-income countries, particularly for vulnerable groups.6 Comprehensive health benefit packages must prioritize early screening and treatment of risk factors such as diabetes and hypertension, access to essential medicines and the implementation of public health interventions to prevent disease progression.8 Targeted support programmes are also needed as part of a comprehensive strategy to strengthen financial protection for chronic kidney disease patients.