PM National Dialysis Programme enhancing availability & affordability of dialysis services: Kamal Shah

Pradhan Mantri National Dialysis Programme is a significant effort to address the growing burden of kidney disease in India by enhancing the availability and affordability of crucial dialysis services, said Kamal D Shah, co-founder, NephroPlus.

India’s dialysis industry has experienced significant growth in recent years, driven primarily by increasing government support and increased prevalence of pure-play dialysis providers. A key factor in this transformation is the government’s focus on making dialysis treatments more accessible. The launch of the Pradhan Mantri National Dialysis Programme in 2016, under the National Health Mission, was aimed to provide free dialysis in public hospitals, especially benefiting low-income patients. This initiative, along with health insurance programs like Ayushman Bharat and several dialysis programs run by the states have significantly expanded access to dialysis across the country. While access has improved, disparities between urban and rural areas persist, he added.

Amounts vary from state to state and from programme to programme. Under the Ayushman Bharat Scheme, the government recognizes the need for flexibility in healthcare delivery, particularly for critical services like dialysis. The scheme reimburses dialysis providers at different rates depending on the location, acknowledging the varying costs and challenges associated with delivering healthcare across different regions, said Shah.

Quality of care in dialysis centres has also improved due to government and private sector initiatives. A visible trend is that of government tenders for dialysis projects using a Quality & Cost Based Selection (QCBS) score while deciding the winner of a tender rather than simply going for the lowest bidder unlike the past. This has resulted in a significant improvement in dialysis quality in government-funded programmes as well. Healthcare providers are focusing on patient awareness and compliance which have become crucial in managing chronic kidney disease and ensuring better outcomes from dialysis, he noted.

Karnataka government recently adopted the QCBS system for their latest dialysis project. This evaluates bidders based on a weighted average of both quality and cost metrics, marks a shift from the traditional practice of awarding contracts solely based on the lowest bid. Other government institutions followed suit in embracing QCBS are Rajendra Institute of Medical Sciences in Ranchi, AIIMS Gorakhpur, and Maharaja Agrasen Medical College in Hisar. This reflects a broader recognition that essential services like dialysis should not be outsourced purely on cost considerations, a practice that has often resulted in suboptimal patient outcomes and compromised service quality. QCBS brings much-needed stability to critical healthcare services like dialysis, noted Shah.

Newer dialysis modalities, such as Hemodiafiltration (HDF), are gaining traction in India. HDF combines the benefits of haemodialysis and filtration, offer improved toxin removal and potentially better long-term outcomes for patients. While still in its early stages, HDF is becoming more popular, especially in specialized centres. However, the cost and complexity of setting up HDF units remain a barrier to its widespread adoption.