Guo Xiaoting holds a plastic bag to
the light to check for signs of trouble in its contents, a
yellowish liquid drained from her abdomen. It’s part of a blood-
cleaning process the 25-year-old from central China has repeated
at least twice daily since her kidneys failed five years ago.
“If the liquid is murky, I might have an infection and
need to see a doctor,” says Guo, sitting on a bed in the living
room of her one-bedroom home in Lvliang (pronounced “Lu-
liang”) city in Shanxi province. “Luckily, that’s not
Infections may be catastrophic for Guo and her husband, who
are already struggling with medical bills larger than their
income. China, with four times as many chronic kidney disease
sufferers as the U.S., spent twice as much on health care last
year than in 2008 and health insurance coverage more than
tripled to 96 percent of citizens last year compared with 2003.
Still, surging rates of kidney disease, diabetes and other long-
term ailments are ratcheting up costs for families like Guo’s.
China has about 1.5 million patients like Guo whose kidneys
are so damaged they stop working, requiring life-long dialysis
or transplants. That number may double to 3 million within a
decade, spurred by diabetes, which damages the organs, according
to Shandong Weigao Group Medical Polymer Co. (1066) The maker of renal-
care products based in Weihai City, Shandong Province, announced
March 18 a joint venture with Terumo Corp. (4543), Japan’s largest
medical device maker, to improve access to dialysis in China.
The market for blood purification treatments there is worth
about 10 billion yuan ($1.6 billion) a year, according to Jason Siu, a health-care analyst with OSK (Asia) Securities Hong Kong
Ltd. It could expand sevenfold if services are extended to all
China’s end-stage renal disease patients, Siu said in a March 15
A petite woman with a three-year-old daughter, Guo is one
of about 120 million people in China with chronic kidney
disease, a condition mostly sparked by infection, excessive
blood-sugar caused by diabetes, or high blood pressure, which
Guo also suffers.
Guo says she can only afford to filter waste from her blood
twice a day, instead of the three times her doctor advises,
increasing her risk of heart disease and stroke. Like most
people in China, her medical bills are rising even after the
government increased health-care spending to 174.8 billion yuan
last year from 82.6 billion yuan in 2008. It earmarked 203.5
billion yuan for 2012, a 16 percent increase.
Thirteen percent of Chinese households last year footed so-
called catastrophic health expenses — accounting for at least
40 percent of their income — compared with 12 percent in 2003,
the Lancet medical journal reported March 3. Health costs as a
share of total household expenditure increased to an average of
13 percent from 11 percent in the same period.
The government of China tested an insurance program last
year covering catastrophic spending for specific, expensive-to-
treat medical conditions, such as childhood leukemia and
congenital heart disease, said Sarah Barber, leader of the World
Health Organization’s health sectors development team in China.
The plan may be expanded, said Barber, who was a co-author on
the Lancet paper, in an e-mail.
Guo’s monthly medical bills, including home dialysis and
mineral supplements, total 4,500 yuan, she says. In contrast,
she earns 600 yuan a month as a waitress, while her 29-year-old
chef husband, Yang Pingping, brings in 2,000 yuan.
In the five years she’s needed kidney dialysis, Guo was
able to apply for a 40 percent reimbursement only once when she
claimed for three months of treatment worth 14,000 yuan in mid-
2011. “We’re still waiting for the money to be reimbursed,”
says Guo, whose family help pay to ensure she receives the life-
Guo relies on peritoneal dialysis, a procedure in which a
tube fitted into the abdomen is used to create a fluid-filled
cavity that relies on osmosis to extract waste and excess water
from the blood. The government wants to promote home-use of the
procedure as a cheaper alternative to hemodialysis, which is
usually done in the hospital two-to-three times a week.
The savings will enable more people to get treated, Health
Minister Chen Zhu told a meeting on kidney-disease treatment in
Beijing last June.
Hemodialysis is about 10 percent more costly in China
compared with peritoneal dialysis, said Yu Xueqing, director of
the Institute of Nephrology at Sun Yat-Sen University’s First
Affiliated Hospital in Guangdong province. “The difference is
not as high as Western countries as fees for doctor and nurses
are much lower,” he said, adding that the gap will widen as
medical labor costs increase.
$69 Billion Market
The global dialysis market was worth $69 billion in 2010,
Germany’s Fresenius Medical Care AG (FME), the world’s biggest
provider of kidney dialysis, said in its latest annual report.
The Bad Homburg, Germany-based company dominated with a third of
the market, followed by Baxter International Inc. (BAX) of Deerfield,
Illinois, and Stockholm-based Gambro AB (GAMBA).
Peritoneal dialysis “continues to grow very nicely,
particularly in emerging markets like China,” Baxter Chief
Financial Officer Robert J. Hombach told a March 14 Barclays
Capital Global Healthcare Conference.
The company has been working with doctors and the
government in China to make the treatment more cost-effective
and accessible. That includes local manufacturing and an
education programs with Peking University Third Hospital, said
Sanjay Prabhakaran, Baxter’s general manager for China and Hong
Kong, in an e-mailed response to questions.
Fresenius officials declined a request to be interviewed.
Besides Shandong Weigao, local manufacturers include Bain
Medical Equipment (Guangzhou) Co., and Beijing United Jie Ran
Bio-Tech, OSK’s Siu said.
Patients need a better understanding of peritoneal dialysis
and to be more comfortable receiving treatment outside the
hospital for it to take off in China, said Alexander Ng,
associate principal at consultancy firm McKinsey Co. in Hong
Kong. They also need sound knowledge of the procedure to pick up
any complications, he said in a telephone interview.
“With rising rates diabetes in Asia, especially China, the
presence of end-stage renal disease will rise dramatically over
time,” said Juliana Chan, professor of medicine and
therapeutics at the Chinese University of Hong Kong. China has
more than 90 million people with diabetes.
The increasing rate of dialysis is almost entirely due to
diabetes, said Chan, who is also chief executive officer of the
Asia Diabetes Foundation. “If you have diabetes and end-stage
renal disease, within five years 80 percent will die anyway even
with dialysis, because of heart disease, stroke, leg ulcers,”
That’s a cause of concern for patients like Guo.
“Our dream is to save enough to start our own eatery, to
have more income to support the family and give a better life
for our daughter,” her husband, Yang, said. “But it’s
impossible, as all our savings are spent on my wife’s illness.”
To contact Bloomberg News staff for this story:
Daryl Loo in Beijing at
To contact the editor responsible for this story:
Jason Gale at