1. Both the treatments, Haemodialysis (HD) and Continuous Ambulatory Peritoneal Dialysis (CAPD) treat the same disease, i.e. kidney failure 

If there are two ways of treating a disease, and one of them is getting reimbursed then the other must also be reimbursed. In case of HD, the patient has to go to the center for taking dialysis. But in case of CAPD, the patient is always treated at home. There is no need for the patient to go to the hospital. Both the treatments are curing the same ailment, that is, kidney failure. 
 
 

2. CAPD is a life saving treatment 

CAPD is a life saving treatment. If not taken by the patient continuously, it can be fatal for the patient. 
 
 

3. Choice of treatment is not in patient’s hand. 

If this would have been true, then all kidney failure patients would have gone for kidney transplant, which is the best option. But many other, medical, financial and physical reasons also effect the choice of treatment. 
  1. If a patient has cardiovascular disease, he/she would do better on CAPD. 
  2. If a patient is having any transmissible disease, it would be better that he/she takes CAPD. If he takes HD, he/she can transmit his disease to other patients. 
  3. If the patient has unstable vascular disease, because of which a proper fistula would not be possible, CAPD is the only option for him/her.
  4. Generally, children under the age of five do not tolerate HD. So CAPD would be the only option for them. 
  5. It has been proved that younger diabetic kidney failure patients live better and longer on CAPD compared to HD. 
  6. If the patient is living far from a HD center, it would be safe, and convenient to take CAPD. 
  7. If the patient has variable schedule, travel and independent life style, CAPD would suit him/her better than HD. 

So if a patient has to take CAPD instead of HD, he must not be penalized by denying any reimbursement, only on the basis that he takes treatment at home. The pain TO both the patients, one on HD and other on CAPD is same. 
 

4. Kidney failure is incurable 

Kidney failure is an incurable disease. There is no cure for this disease. We can only extend the life of a kidney failure patient. The patient does not have any option but to take the treatment. If the patient wants to live he has to take dialysis or transplantation. If HD is denied, on any grounds, and transplantation is not possible, the patient has to go for CAPD, which becomes the only hope for life. By denying reimbursement, we are denying him the right to live.
 

5. Increase in living probability 

By reimbursing the patient taking CAPD, we will be increasing the living probability of the patient. CAPD is costlier than HD, in India. So most of the patients take treatment for sometime, and when it becomes financially unbearable, leave the treatment.
 

6. HD is the age old treatment for kidney failure where as CAPD is new treatment. 

As medical science makes new breakthroughs, for the same disease new, safe and effective treatments are found out. CAPD has evolved in the last 25-30 years and it is a new treatment. It was started in 1978 by Dr. R Popovich and Dr. J Monchrief in USA. But because it is new, it should not be included in the reimbursement list, is a wrong logic. 
 

7. Haemodialysis is itself an exception to the rule of Mediclaim of minimum hospitalization. 

For HD, a patient goes to a dialysis center for 4-5 hours, 3 days in a week. He is not hospitalized for 24 hours on any of these days. But under the exceptions to Mediclaim policy it has been rightly covered, as there is a constant expense for the patient. 

Similarly, patient on CAPD must also get the advantage of Mediclaim through an exception to the rule. 
 

8. HD and CAPD are replaceable treatments to some extent. 

CAPD can be, in few cases replaced by HD. By denying reimbursement of CAPD, the patients will always be tempted to go for HD. This will create a negative impression on the minds of patients and Nephrologists by limiting their choice. 
 

9. Cost of infrastructure to provide HD to all the patients would be very prohibitive whereas for CAPD minimum infrastructure is required. 

The infrastructure required for HD is as follows : A building, dialysis machines, RO-DM plant, Dialysis technicians, nurses, engineers and so on. It becomes very expensive and complicated process to run a dialysis center. 

On the other hand, in CAPD patients home becomes the building needed for taking dialysis. His peritoneum becomes the machine for dialysis. There is no need for RO-DM plant, dialysis technicians, nurses and engineers. Once the patient or his attendant has been trained for doing the exchanges, there is no need for another person for dialysis. Depending on the condition of the patient, the patient visits the doctor. 

If CAPD is reimbursed, more and more people will turn towards CAPD and get treated without increasing the load on the existing dialysis centers and the health department. 

In countries like Mexico, this policy of promoting CAPD has been followed and many more patients are getting treatment without the need of investment from the Government. 
 

10. Medicare programme in the USA also reimburses the CAPD expenses 

Medicare programme, which reimburses the costs of dialysis or transplant in the US, also pays for CAPD expenses.
 
Representation for increase in the permissible limits for kidney failure treatment

14th November, 2003 

To, 
The Finance Minister 
Government of India, 
North Block, 
New Delhi 

Re : Representation for increase in the permissible limits for kidney failure treatment 


Hon’ble Shri Jaswant Singhji, 

India Renal Foundation (IRF) is a not-for-profit voluntary health organisation, dedicated to the service and rehabilitation of kidney failure patients in India. The main objectives with which IRF has been set up are prevention & awareness about kidney failure, developing trained technical and nursing staff, providing financial assistance for treatment to kidney failure patients, providing infrastructure for quality dialysis treatment and care, networking for organ donation, developing bench marks in the area of treatment of kidney failure and assisting research in the area of Nephrology. 

Section 80 DDB of the Income Tax Act provides for a deduction for the expenditure incurred on the medical treatment of specified diseases which interalia includes renal (kidney) failure, along with other diseases under rule 11 DD. The deduction allowed for the specified ailments is a lump sum of Rs. 40,000/- (Rupees fourty thousand only) and if the person suffering is a senior citizen, the deduction permissible in his case is Rs. 60,000/- (Rupees sixty thousand only). 

Sir, as regards the kidney related ailments, we wish to present to you the details of regular yearly expenses to be incurred by a patient if he regularly undergoes treatment. Enclosed kindly find herewith a note presenting the details of the same. (Annexure A) 

You will kindly appreciate that the present limits of permissible deduction are very low and need to be revised upwards. These kidney failure patients pass through a great agony and are disturbed physically, mentally and emotionally to a great extent. If the assesse/or his or her family incurs expenditure to keep him in reasonably good condition, and make his life worth living, we feel that such expenses must be allowed as permissible expenses under the Income Tax provisions. 

We therefore request you to kindly give a sympathetic consideration to our above submissions and revise the limits upwards suitably. 


Thanking you.