A sudden hike in the duties on imported dialysers used to treat patients with end-stage kidney disease has put a further burden on those struggling to handle treatment cost.
Dialysers, or haemo-dialysers are machines used to purify the blood of patients whose kidneys fail to do so.
The recent increase of duties from about 8 per cent to nearly 23 per cent on ‘Disposable Sterilised Dialyser’ and ‘Microbarrier’ categories is bound to drive the cost up substantially. The duties have gone up, due to interpretation of customs authorities, who have re-classified the products earlier slotted under the category ‘artificial kidneys’ into the category ‘filters’ which attract a higher duty percentage, according to industry sources.
“At some point, the rise in duty will be passed on to the patient, and she is already hard pressed for finances as haemodialysis is expensive,” said Rajan Ravichandran, senior nephrologist, who heads the MIOT Institute of Nephrology. The cost per dialysis will go up by 15 – 20 per cent, he reckoned.
Georgi Abraham, director, Nephrology, Madras Medical Mission, said there are about 90,000 people on maintenance haemodialysis whereas the annual incidence of kidney failure in India is about 200 per million population.
Since haemodialysis machines are not manufactured in India, they have to be imported. Prices have gone up because of the falling rupee against the dollar, said Indian representatives of one dialyser manufacturer. Some of them have got together to write to the customs department and ministry of finance to reconsider the move.
In a letter to Vayalar Ravi, Minister for Overseas Indian Affairs, Dr. Georgi urged the government to waive off custom duties, levies and local taxes for dialysis machines, and consumables. This will be a big boon to patients, he said.
The cost of dialysis has already gone up for Tanker Foundation, an NGO that provides free and subsidised procedures for patients, according to its managing trustee Latha Kumaraswami. “This means we have to collect more funds to make up the difference that has now cropped up. We cannot transfer the cost onto patients; we also benefit from being a part of the Chief Minister’s Comprehensive Insurance Scheme in Tamil Nadu.”
But for Bhaskar Reddy, an ex-Port Trust employee, who has been on dialysis for the last five years after two transplants failed, there is no largesse to fall back on. He took voluntary retirement because of his medical condition and is now forced to fund his own medical expenses. “I spend between Rs. 30,000 and Rs. 35,000 every month, on dialysis, and various medications.” The thought of an increase of 15 per cent is daunting to him.
“The only solution is for both Central and State governments to provide subsidies for patients on dialysis. It simply costs too much for average middle class people like me.” And the reality is that there are more people like him, some of whom may be worse off financially, than those able to afford dialysis.
“Some governments offer dialysis facilities, and certain concessions such as VAT exemptions. But the facilities are few and far between, there are many patients not covered under any schemes, even insurance. In this scenario, raising duties will make a bad situation worse,” Dr. Ravichandran said.
“Every year, the cost goes up, and there is a 7-8 per cent increase in dialysis charges because of running cost and salaries to technicians. Since we import the equipment, we also have to contend with the unfavourable exchange rate,” Dr. Georgi said. Many patients, who have been advised dialysis three times a week, begin with three and then cut it down to two a week because they cannot afford it. To further add to the cost would come in the way of people continuing with the life saving procedure, he added.
