In defense of travel or why the provision of dialysis should accomodate travel

By Bill Peckham

Anu writes in comments of her desire to travel from India to Canada. Unfortunately the only way for her to do this while using hemodialysis to treat her CKD5 is to pay from her own pocket. I am not sure what a dialysis treatment would cost in Canada, the only time I have dialyzed in Canada it was on a boat in Sydney marina using the NxStage System One, but I am sure it is hundreds of dollars. Having to pay the marginal dialysis costs would be one thing but visitors have to pay the full counter rate, this is what is keeping Anu home.

This is a problem with a solution but before it can be fixed it has to be understood to be a problem. It's a problem, understand?

Travel matters. The point of dialysis is to allow people to live the life they were meant to live, dialyze to live, don't live to dialyze as is so often said. Travel is a part of that, travel is an important part of the life I am dialyzing to enjoy. Travel matters.

I travel as a part of a full life. I have a fear that in the US the new expanded dialysis payment bundle will be rolled out as a monthly payment. Even a per treatment expanded bundle payment has the potential to create a small barrier to travel within the US but a monthly payment frequency would be a large barrier to travel. The fear, that US government payment systems are indifferent to the importance of travel, is well founded. Medicare payments stop at the US border and people whose dialysis is funded by Medicaid are often confined to their home state because Medicaid will not reimburse for out of state medical care. This is not how it should be, dialysis funding schemes should be designed to accommodate travel.

Yesterday RenalWeb linked to an article from Arab News telling of free hemodialysis provided to pilgrims completing the Hajj (I believe Saudi Arabia also provides free dialysis to those on the Umrah, a pilgrimage to Mecca outside the week designated for the Hajj). However, providing dialysis to foreign visitors does not have to be based on Saudi Arabia's charity model. You could also accommodate international travel through a dialysis exchange program.

To take Anu's example, I will assume she is dialyzing incenter. The details can get confusing because in Canada the funding varies from Province to Province - there are different buckets of money - and I am sure there is a range of funding schemes in India as well but someone is paying some amount per treatment. If a person on dialysis in Canada would visit India at the same time Anu visited Canada the payment for both treatments could stay the same - Anu's funding would pay for the Canadian's treatment in India while the Canadian's funding would pay for Anu's treatment in Canada. They would literally take each others place at no cost to the funding system. Accommodating travel in this way is budget neutral.

Setting up paired travel wouldn't work but creating travel banks between countries could. While the decentralized nature of dialysis in India would make it harder to implement for Anu, it should be possible between Canada and the US, using Medicare as the US standard of reimbursement. The Dialysis Exchange Bank could be started slowly and grow with demand. It could be done in a budget neutral way with administration handled by a donation supported nonprofit. If you've always wanted to see Paris Toronto, dialysis shouldn't be the thing that stands in your way. It can be done but first payers must understand that travel matters.

EDIT - thanks to Kamal for pointing out my pronoun misuse

Comments

[Zach]

Travel, who has money for travel?
:)