Impact of supplemental private health insurance on dialysis and outcomes

Abstract

Background: The influence of health insurance systems on the treatment of end-stage kidney disease (ESKD) patients ispoorly understood.Aim: We investigated how supplemental private health insurance (PHI) coverage impacted ESKD treatment modalitiesand patient outcomes. The influence of health insurance systems on the treatment of end-stage kidney disease (ESKD) patients is poorly understood. We investigated how supplemental private health insurance (PHI) coverage impacted ESKD treatment modalities and patient outcomes.Methods: All adult patients commencing ESKD treatment in New South Wales, Australia from 2000 to 2010 were identified using the Australia and New Zealand Dialysis and Transplant Registry. Data were linked to the state hospitalisation dataset to obtain insurance status, allowing the comparisons of mortality, ESKD treatment modality and health service utilisation between privately insured and public patients.Results: The cohort of 5737 patients included 38% (n = 2152) with PHI. At 1 year after ESKD treatment initiation, PHI patients had lower mortality (hazard ratio 0.84, 95% confidence interval (CI) 0.74-0.95, P = 0.01), were more likely to be receiving home haemodialysis (HD) (odds ratio (OR) 1.38, 95% CI 1.01-1.89, P = 0.04), to have been transplanted (OR 1.75, 95% CI 1.25-2.46, P = 0.001) and used fewer hospital days (incidence rate ratio 0.85, 95% CI 0.74-0.96, P = 0.01). After adjustment, PHI patients were more likely to initiate ESKD treatment with facility-based HD (OR 1.22, 95% CI 1.01-1.46, P = 0.03) but were less likely to be started on peritoneal dialysis (OR 0.81, 95% CI 0.67-0.98, P = 0.03). Conclusion:Our findings suggest that supplemental PHI in Australia is associated with lower-risk ESKD treatment attributes and improved health outcomes. A greater understanding of the treatment pathways that deliver these outcomes may inform treatment for the broader ESKD treatment population.

Health Insurance Status Is Related to Risk of Mortality and Hospitalization in Korean Maintenance Hemodialysis Patients: A Longitudinal Cohort Study

“…Our finding is similar to that found in the recent studies performed in Australia [21]. Krishnasamy et al [21] demonstrated in their article that low SES adversely affects dialysis survival in Australia [15], but SES had minimal impact on biochemical parameters or dialysis adequacy. They suggested that low SES may increase mortality due to predialysis factors and other variables such as health-related behaviors, lifestyle, and literacy.…”

“…There are several studies using health insurance status as a proxy indicator of SES to assess clinical outcome in dialysis patients [11][12][13][14]. However, many studies included the heterogeneous population with various race/ethnicity and unpredictable factors such as private insurance premium coverage [15].…”

Does school-based private health insurance improve students’ health status? Evidence from China

“…While previous studies focus on adult populations in developed countries, this study considers the children population in a developing country and finds similar conclusions. Private health insurance enables individuals to obtain optimal therapy regardless of age and nationality (Bhattacharya et al, 2003;Sriravindrarajah et al, 2020). Additionally, this study finds that uniform private health insurance has a negligible impact on student health status.…”

“…They found that extending private insurance coverage to working-age adults may result in improved health. Research on the impact of private insurance on populations like HIV patients over 18 years old in the United States (Bhattacharya et al, 2003), end-stage kidney disease adult patients in Australia (Sriravindrarajah et al, 2020), and women age 35-64 years with breast cancer in New Jersey (Ayanian et al, 1993) has been conducted. Private health insurance is more effective than public insurance in preventing HIV-related deaths (Bhattacharya et al, 2003) and is improves health outcomes among patients (Ayanian et al, 1993;Sriravindrarajah et al, 2020).…”

The Effect of Additional Private Health Insurance on Mortality in the Context of Universal Public Health Insurance

“…Older individuals and people with past medical histories often face higher insurance costs or other difficulties when acquiring PHI [6]. If mortality differs depending on PHI status in this context, this would suggest that there are health inequalities that result in varying degrees of coverage according to socioeconomic status (SES) [7][8][9][10][11]. Very few studies have examined whether PHI registration influences mortality under a public health insurance system that provides UHC.…”