Christina Bradshaw, MD

christinabradshawGHES US Fellow 2016-2017

E-mail: clbradshaw85@gmail.com
Fellowship Site: Kerala, India
U.S. Institution: Stanford Medical School

Project Title: Microeconomic impact of dialysis care triggers for withdrawal in ESRD patients in Kerala, India

The financial impact of healthcare cost of end-stage renal disease (ESRD) on households can be crippling, and potentially renders palliative care options as cost-prohibitive.  According to the Indian Renal Foundation, the average monthly cost of dialysis is 12,000-15,000 rupees ($179-$223 US dollars). However, the average Indian monthly wage in 2012 was only $111 (International Labor Organization). It is not surprising, therefore, that for many kidney disease patients the diagnosis of ESRD is essentially a death sentence. Although there are some institutions that offer a modest subsidy to those patients who can partially pay for their dialysis care (e.g.the Bangalore Kidney Foundation), the majority of the ESRD population cannot afford to do so and are forced into profound debt or a hastened death. With further research into the economic hardship of ESRD, we hope to not only raise awareness of this problem but also introduce alternative solutions, such as government-sponsored coverage and palliative care. Furthermore, by increasing the public’s knowledge of the challenges that come with ESRD at the outset, we can help kidney disease patients better prepare for the future and perhaps decrease their overall morbidity.

Objectives:

1. Describe the economic effects of chronic dialysis care on household productivity and incomes

2. Describe the correlation between payment ability/financial status on incident hospitalization

3. Investigate the prevalence of ESRD patients offered palliative care options

4. Describe rates of and reasons for withdrawal from ESRD care