The Insurance Chapter in Policies for Peritoneal Dialysis: From a Patient’s Perspective

Among the two types of dialysis— Haemodialysis and Peritoneal Dialysis (PD) or home-based dialysis, the latter is preferred by most patients.

When the new strain of COVID-19 overstretched healthcare systems around the world, little did we know that many patients with chronic diseases will be at the receiving end of the spectrum too. In a country where 2.2 lakh new patients face kidney failure each year, 4950 dialysis centres are clearly not enough for the demand for 3.4 crore dialysis each year. Among the two types of dialysis— Haemodialysis and Peritoneal Dialysis (PD) or home-based dialysis, the latter is preferred by most patients. Now, with the pandemic bringing about a seismic shift in the way we treat patients, accessibility is key. As per recent reports, PD, which was long missing from policies to help patients who need dialysis, IRDAI in its recent policy stated, “Insurers should not deny coverage for claims of PD, where dialysis is allowed subject to product design.”

Coverage in health insurance policies for PD along with other diseases which were earlier excluded or are not covered in health insurance products so far is now being covered since October 2020 by all insurance companies. Standardisation of health will make life easier for kidney failure patients and will provide clarity on what the health insurance company is covering under the chosen plan. This win-win situation will enable customers to compare and get the most suited plan for themselves.

The Insurance Advantage

Private insurance matters now more than ever, as patients are restricted access to many healthcare facilities. At the same time, with the steep spike in COVID-19 cases, fear of contracting the infection is further limiting patients’ access to hospitals. According to statistics, there are about 6,500 patients on PD in India, and these patients need the treatment at regular intervals. Ideally, PD should be made accessible to more people in the country because of the added advantages, and insurance is a tool that will aid this journey. The cost of PD supplies is high, with taxes and duties adding to the burden.

What does this mean for patients who are suffering from chronic kidney disease? For decades, patients avoided PD due to the unaffordability factor. Since it was not covered under insurance schemes, many patients were of the opinion that the set up at home would cost them a lot more than simply getting dialysis done at a centre. Moreover, many patients believed in common myths like PD could lead to more infections and is not suitable for patients living in the low socio-economic bracket. For long, India struggled to make any form of dialysis available to its patients, however, in the last few years, dialysis has been making inroads into Tier 2 and even Tier 3 cities. Having said that, as per the guidelines for establishing PD services under PMNDP, “Still, dialysis remains hard to access for large number of patients living in remote rural areas. They can benefit more from home-based dialysis like PD.”

The PD advantage

To understand the advantages of PD, it is important to understand how it works. During the treatment, a surgery is conducted to place a soft plastic tube (catheter) in your belly. In PD, the lining inside the patient’s belly acts as a natural filter. The catheter is used to make access for a sterile fluid called dialysate into the belly. Now, once the filtering is over, the wastes leave the body as dialysate is washed in and out of the body. The waste is drawn out of your blood, in the dialysate. This can easily be done at home without extensive hospitals visits.

Since PD takes away the need for frequent fluid balance changes, it helps patients lead a more flexible lifestyle. For those who travel frequently, PD helps them live their lifestyles without added interruptions. That said, we still lack awareness on the subject. Whether a patient needs PD or not is something only a doctor can decide. What we must understand is that when PD was included in PMNDP, the objective was to increase access to dialysis and transplantation.

The government wanted to “provide financial risk protection to patients, and to minimize the impact on the overall national health care budget”. We can learn from countries like Thailand where PD has relatively lower cost for providers. Simply put, PD will reduce our dependence on healthcare provider staff, reduced travel time and cost for patients.