Reimbursement of Dialysis

Abstract

Reimbursement for chronic dialysis consumes a substantial portion of healthcare costs for a relatively small proportion of the total population. Each country has a unique reimbursement system that attempts to control rising costs. Thus, comparing the reimbursement systems between countries might be helpful to find solutions to minimize costs to society without jeopardizing quality of treatment and outcomes. We conducted a survey of seven countries to compare crude reimbursement for various dialysis modalities and evaluated additional factors, such as inclusion of drugs or physician payments in the reimbursement package, adjustment in rates for specific patient subgroups, and pay for performance therapeutic thresholds. The comparison examines the United States, the province of Ontario in Canada, and five European countries (Belgium, France, Germany, The Netherlands, and the United Kingdom). Important differences between countries exist, resulting in as much as a 3.3-fold difference between highest and lowest reimbursement rates for chronic hemodialysis. Differences persist even when our data were adjusted for per capita gross domestic product. Reimbursement for peritoneal dialysis is lower in most countries except Germany and the United States. The United Kingdom is the only country that has implemented an incentive if patients use an arteriovenous fistula. Although home hemodialysis (prolonged or daily dialysis) allows greater flexibility and better patient outcomes, reimbursement is only incentivized in The Netherlands. Unfortunately, it is not yet clear that such differences save money or improve quality of care. Future research should focus on directly testing both outcomes.

Socioeconomic Differences in the Uptake of Home Dialysis

“…Some countries and states provide incentives for increasing the proportion of patients who use PD within publicly funded systems (25,27). Medicare in the United States essentially reimburses a flat price per week per patient, regardless of modality, whereas in Germany, more is paid for PD (28). Funding structures used by private providers have received little attention, although similar approaches may address some disparities.…”

International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study

“…By contrast, reimbursement generally is not conditioned on achievement of specific Hb levels in many European countries. 34 Thus, European providers may be less concerned, for reimbursement reasons, with occasional excursions of Hb levels into the ERBP gray area of 11.5-13.5 g/dl.…”

What Can We Expect from On-Line Hemodiafiltration?

“…With this, ‘the restriction of indication' disappeared. This is the first establishment of a technical fee for ol-HDF in the world [4]. As a facility requirement, the calculation of ‘addition for maintaining dialysis fluid water quality' was added (table 1).…”