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HindustanTimes Tue,02 Sep 2014

A bitter bill to swallow, for life

Menaka Rao, Hindustan Times  Mumbai, December 13, 2012
First Published: 01:14 IST(13/12/2012) | Last Updated: 01:58 IST(13/12/2012)

For those suffering from lasting diseases such as diabetes and hepatitis, there is no respite from ever-increasing medical costs, and the damage these ailments do to vital organs such as the kidneys and liver often forces patients to undergo expensive transplants as well, says Menaka Rao.

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Every month, theatre actor Vrishali Gandhe has to keep aside about Rs. 4,000 for medical expenses. A diabetic for nearly seven years, Gandhe now needs to take insulin four times a day. 

“My expenses have only increased since I was detected with diabetes.  I am too scared to take up any theatre or television assignments — I get tired too easily,” said Gandhe, a Mahim resident.

In addition to the cost of her medicines, she has to spend about Rs. 1,000 every month on investigations such as blood sugar tests, glucometre strips and lipid profiles. Then there are doctors’ fees.

Diabetes is a chronic condition in which the body does not produce enough or effectively use insulin, leading to excess sugar in the blood. According to the International Diabetes Federation about 61 million Indians suffer from diabetes and spend an average of $1,270 ( Rs. 68,800) a year on keeping it in check — more than the country’s annual per capita income.

Costs increase even further if patients use more advanced treatment techniques. “If a patient uses insulin pens, glucometers and other newer technology, it works out more expensive.  As the disease advances, the cost of managing and monitoring it also increases,” said Dr Vyankatesh Shivane, a consultant diabetologist who is treating Gandhe.

Dr Shivane said the average expenditure of Rs3,000 or Rs4,000 is particularly difficult for lower-middle class patients, who may earn only about Rs10,000 a month. “We have to remember that even if a person is insured, insurance companies do not pay outpatient (non-hospitalisation) costs,” he added.

While many diabetics take their illness very seriously for the first few months, compliance to treatment routines and follow-ups fizzle out within a year, doctors said. This, according to them, increases complications or leads to the development of co-morbidities such as kidney disease, diabetes retinopathy (which affects vision), high blood pressure and cardiac problems. 

“In the early stages, when the disease has just been detected, people come for regular follow-ups and check their blood sugar often. But after a few months, the checkups are done only once in three-four months, or as and when symptoms crop up. Six to eight years after diabetes is detected, related complications surface,” said Dr Somil Mehtaliya, consultant diabetologist, Kohinoor Hospital, Kurla. “If the disease is managed well, the onset of these complications can be delayed by five, even ten years”.

Among the most dangerous of ailments a diabetic can suffer is kidney failure, which can arise because blood sugar levels have not been maintained. “About 40% of diabetics suffer from kidney disease. The patient has to spend even more money on testing for kidney functions and to treat it early,” said Dr Umesh Khanna, consultant nephrologist, BSES Hospital, Andheri. 

If the kidney fails, the patient has to undergo dialysis, which can cost up to Rs25,000 a month, or undergo a kidney transplant, which can cost up to Rs5 lakh for the surgery and Rs. 10,000 a month for post-operative treatment, Dr Khanna said.

Case Study

‘Expenditure has tripled in last 6 years’

Mumbai: Nirmala Dedhia, 52 ran a successful beauty parlour in Nalasopara till about six years ago, when doctors detected she had diabetes. Now, with expenses for the treatment mounting, her family is wondering whether they should delay her son’s wedding.

The disease’s first symptoms were drastic weight loss and extreme fatigue. “I could not even walk for five minutes. I went to the family doctor who asked me to check my blood sugar,” said Dedhia, a Borivli resident.

A year after the diabetes was detected, she suffered a series of complications. “My vision dimmed in 2007 and I was detected with diabetes retinopathy for which I had to undergo surgery,” said Dedhia, who has been on insulin for the past four years.

Around the same time, Dedhia suffered from headaches and high blood pressure. When her doctors checked, her kidney functions had been affected. For a year, she managed the disease with medicines, but her kidneys failed after about a year of treatment.
 
“I have to undergo dialysis three times a week now,” said Dedhia. She spends Rs. 12,000 a month on just the dialysis, in addition to the medication (insulin) and the other kinds of treatment and investigation she has to undergo to manage the disease.
 
“Earlier I could do all my work myself. Now, I need a domestic help and a person to take me to the dialysis centre. My income has reduced and expenses have tripled, and I cannot afford a kidney transplant.”

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