Influence of Different Payment Schemes on the Clinical Outcome in Peritoneal Dialysis Patients

Abstract

♦ Background: Cost is always a big issue for dialysis patients. In the present study, we analyzed the effect of different payment schemes on dialysis adequacy and clinical outcome in our peritoneal dialysis program. ♦ Methods: This is a single-center cohort study. A total of 175 patients who began dialysis from January 2006 to December 2007 were included. Baseline data, including volume status, dietary intake and nutrition status, dialysis adequacy, and sodium removal were collected at 6 months after peritoneal dialysis. Based on the different payment schemes, the patients were divided into 2 groups, higher payment group (GHP, 130 cases, with more than 85% reimbursement), and lower payment group (GLP, 45 cases, with less than 50% payment or totally self-paid). Patients were followed up until dropout or until December 31, 2013. KEY WORDS: End-stage renal disease; continuous ambulatory peritoneal dialysis; outcome; socio-economic status; dialysis adequacy; lifestyle modification; healthcare payment. P eritoneal dialysis (PD) is an effective therapy for end-stage renal disease (ESRD). Cost is always a big issue for this kind of patient and for society as a whole, especially in developing countries (1). Due to its lower cost, PD is more commonly used than hemodialysis (HD) in Hong Kong (HK) (1). However, the cost advantage of PD in mainland China is less than it is in HK.Healthcare coverage is not universal in mainland China. There are several reimbursement systems or payment schemes, namely free medical service (FMS, mainly for government officials and employees), medical insurance system (MI, mainly for urban workers and citizens), and new rural cooperative medical scheme (NCMS) for farmers. The reimbursement percentage (payment received/actual cost) was different among these different payment schemes and also different in different areas, even under the same payment scheme, depending on the regional economic level. For example, in Beijing, in 2006 and 2007, FMS had the highest reimbursement rate, with 90% or even a higher percentage of the dialysis cost being supported for the patients under this payment system, while reimbursement was about 85% for the MI system, and 30%~50% for the NCMS. Besides the 3 abovementioned payment systems, there were some patients at that time who did not have SU et al. MARCH 2016 -VOL. 36, NO. 2 PDI any insurance coverage. These non-insured patients included some old urban citizens and children, and some peasants who did not attend NCMS. Many of the self-paid patients did not receive dialysis treatment, which was the primary reason for the lower prevalence rate of dialysis in mainland China. Although in recent years, the Chinese government has made a substantial effort to make the healthcare plan cover the whole population and the National Development and Reform Commission had announced that 95% of the Chinese population had been covered by the 3 different healthcare plans at the end of 2011, the financial support for many dialysis patients is still not adequate, particularly f...

Daily self‐care practices influence exit‐site condition in patients having peritoneal dialysis: A multicenter cross‐sectional survey

“…It had been reported that there was a strong association between a treated ESI and subsequent peritonitis up to 60 days after initial diagnosis (van Diepen et al., 2012). Although we reported that the overall peritonitis rate in our program was one episode every 75.87 patient months (Su et al., 2012), peritonitis remains the major cause of patient transfer to HD in our program (Su et al., 2016). The proper care of exit‐site plays a pivotal role in CRI prevention.…”

Longitudinal association between dietary protein intake and survival in peritoneal dialysis patients

“…We recommend prescribing a dietary protein intake of at least 0.8 g/kg of protein and 25 kcal/kg of energy based on previous clinical findings in the Chinese PD population and the guideline from EBPG [ 13 , 15 , 16 , 20 ]. For patients with decreased dietary intake, the doctors would check whether they had some complications and gave them treatment accordingly.…”

“…Many published studies also suggested that patients with PD could maintain good nutritional status with a protein intake of 0.8 g/kg/d [ 11–16 ]. Meanwhile, many prior studies that examined the association between DPI and survival evaluated only the effect of the initial or baseline DPI, obtained at the start of the study, on subsequent mortality [ 15 , 17 , 18 ]. There is still a paucity of controlled metabolic studies, as well as long-term well-designed clinical trials, studying protein intake in PD patients.…”