Financial strain beyond coverage: assessing out-of-pocket costs for dialysis care in chronic kidney disease at a tertiary care centre in Central India

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) was launched in 2018 to reduce financial risk arising out of catastrophic health expenditure. Chronic dialysis is one of the costliest treatments and PMJAY has emerged as one of the most important method of subsidizing dialysis allowing many patient to afford dialysis. In fact dialysis has become the most sought after treatment under PMJAY. Despite subsidies from PMJAY, patients often have out of pocket expenditure in accessing dialysis services. To assess the out-of-pocket expenditure in accessing dialysis services among chronic kidney disease patients in Central India. This hospital-based cross-sectional study was conducted among stable hemodialysis patients attending a tertiary care teaching hospital in the state of Chhattisgarh. A semi-structured questionnaire was used to collect the socio-demographic and clinical details. The participants were asked to provide details of out-of-pocket expenditure, including the charges of direct medical expenses and indirect medical expenses. Costs were reported as median values with interquartile range. A total of 99 hemodialysis patients took part in this study. Median age was 43 (IQR: 34–54) years and the median distance travelled to avail dialysis was 30 (IQR:7-85.8) kilometres. Thirty-three patients who initially received dialysis at a private setup subsequently transitioned to a public dialysis facility, with a mean interval of 19 months. 25 (25.3%) received PMJAY (Ayushman card) subsidies at the initiation of hemodialysis, but in the later part, this proportion increased to 78 (78.7%) during the course of ongoing dialysis services. The monthly overall out-of-pocket expenditure was INR 17058.3 (IQR: 11922.9–26672.9). Three-fourths have borrowed money to meet the healthcare expenses. The majority of the maintenance hemodialysis patients visiting our centre availed the Ayushman scheme, but still needed other sources to meet their financial healthcare costs. An expanded comprehensive health insurance is needed to address the substantial OOPE borne by the hemodialysis patients on travelling and medications.