Delhi businessman Narendir Kumar, 57, has been undergoing dialysis twice a week at Max hospital's NephroPlus centre ever since he was diagnosed with kidney failure in October last year.
Dialysis - removing waste and excess water from the blood through machines - artificially replaces lost kidney function in people with kidney failure. A session usually takes up to four hours.
What brought Kumar to NephroPlus - a standalone dialysis company operating within Max hospital - was the quality of service and the low prices. "I checked out other places and found that for a premier hospital such as Max, the cost of a dialysis session was quite economical. I pay about Rs 2,500 for a session, and the best part is that quality had not been compromised," he says.
Kumar is picky about quality control. "I know of many people who ended up spending lakhs to treat infections that they contracted during dialysis," he says.
India currently has more than 15 lakh people suffering from end-stage renal disease, with about 2 lakh people being added to that total every year. With a severe shortage of donor organs, the number of patients undergoing dialysis multiple times a week is rising steadily too. And the cost of this treatment can be punishing.
In Delhi, a session costs Rs 2,500 to Rs 3,500. In Mumbai, the average cost per session is Rs 2,000. Across the board, though, prices drop when you turn to the growing number of standalone dialysis centres in Indian cities. NephroPlus, for instance, operates 35 centres in 20 cities, offering the treatment for as little as Rs 1,400 per session in some centres.
"We keep rates down because of the way we operate," says Sohil Bhagat, vice president of strategy at NephroPlus. "We keep our beds full. That brings down costs. We also get special pricing from suppliers." Competitive pricing between the growing number of companies helps keep costs down too. It was the lower cost and lower risk of infection that drove Mumbai businessman Mohammad Islam, 56, to a standalone centre too. Islam was diagnosed with end-stage kidney failure in 2008 and told that he would have to undergo dialysis three times a week.
"After the initial shock wore off, my first thought was of the expense," says the father of eight. "I started going from hospital to hospital, comparing rates."
In most places, the cost per session was about Rs 2,000, but his nephrologist suggested an affordable alternative - a standalone centre called Apex Kidney Care, with seven branches in Mumbai.
Here, the cost per session was considerably lower, at Rs 1,200.
NephroPlus runs the dialysis centre at Max Hospital, Patparganj. One session costs Rs 2,500, compared to Rs 3,900 in Max Super-Speciality, Saket. (Arun Sharma/ HT Photo)
"I also realised that there would be a lower risk of infection than a hospital, since this facility only conducted dialysis," says Islam. "Though government hospitals charge just Rs 400 per session, I never considered seeking treatment there because of the hygiene and infection factors. I didn't want to take any risks since it's a question of life and death."
Islam has been getting his treatments at Apex ever since. "If I need to undergo any related tests, that can also be done at the facility, so it's very convenient," he says.
Apex is one of a growing number of health care companies running standalone dialysis centres in and around Mumbai. Over the past five years, in fact, that total number of such centres has nearly doubled, from 8 to 15, in Mumbai. In the same period, the number of charitable, trust-run standalone centres has more than tripled, from 8 to 28.
These centres are run by companies such as Apex, Lancelot and BK.
"Some of our centres are standalone, some are run within hospitals like Hiranandani, which have out sourced the function," says Dr Shrirang Bichu, nephrologist at Bombay Hospital and co-founder of Apex Kidney Care.
In addition to its 10 standalone centres in Maharashtra and Kerala, for instance, Apex runs another 15 centres within hospitals in Maharashtra, Goa and Gujarat.
"We decided to out source the dialysis centre in 2011 because we found it to be an efficient option and we knew and trusted the doctors involved," says LH Hiranandani Hospital CEO Dr Sujit Chatterjee. "Since Apex specialises in this service, the price is also competitive, with each session costing Rs 1,200 to Rs 1,300."
In many cases, the standalone centres have mushroomed in response to rising demand.
Apex, for instance, started out with the two centres and 40 dialysis machines in 2008. A total of 25 centres run by the company in hospitals and as standalone centres have a total of 300 dialysis machines conducting more than 17,000 treatments a month.
For those who cannot afford the standalone rates either, centres run in government hospitals under public-private partnership (PPP) provide better-quality service almost free.
In Delhi, the first dialysis centre under a PPP partnership started with 10 machines in its Lok Nayak Hospital in 2013. According to DCDC Kidney Care, which runs the centre, the machines have advanced technology and are backed by a sophisticated reverse osmosis plant with remote monitoring to provide the best clinical outcomes.
"This centre demonstrates that very high levels of service can be provided at government-owned facilities almost free," says Aseem Garg, MD of DCDC Kidney Care.