How to meet the demand for good quality renal dialysis as part of universal health coverage in resource-limited settings?

BackgroundIt is very challenging for resource-limited settings to introduce universal health coverage (UHC), particularly regarding the inclusion of high-cost renal dialysis as part of the UHC benefit package. This paper addresses three issues: (1) whether a setting commits to include renal dialysis in its UHC benefit package and if so, why and how; (2) how to ensure quality of renal dialysis services; and (3) how to improve the quality of life of patients using psychosocial and community interventions.DiscussionThis article reviews experiences of renal dialysis programs in seven settings based on presentations and discussions during the International Forum on Peritoneal Dialysis as a Priority Health Policy in Asia. A literature review was conducted to verify and validate the data as well as to fill information gaps presented in the forum.Five out of the seven settings implemented renal dialysis as part of their benefits package, while the other two have pilots or programs in their nascent stage. Renal replacement therapy has become part of the universal access package because these governments recognize the rising number of chronic kidney disease (CKD) cases, the catastrophically high costs of treatment, and that this is the only life-saving treatment available to patients. The recommendations are as follows: Governments should have a holistic approach to CKD interventions, including primary prevention as well as psychosocial interventions. Governments should consider subsidizing CKD treatment costs depending on their resources. Multi-stakeholder cooperation should be facilitated to enact these policies and conduct research and development for all aspects of interventions. International collaboration should be initiated to share experiences, good practices, and joint activities (e.g. capacity building and multinational procurement of medical supplies).ConclusionThis study provides practical recommendations to country governments as well as the international community on how to meet the demand for good quality renal dialysis as part of UHC in resource-limited settings.

[1]  Miranda Mugford,et al.  Economic evaluation of palliative management versus peritoneal dialysis and hemodialysis for end-stage renal disease: evidence for coverage decisions in Thailand. , 2007, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[2]  K. Chow,et al.  The Cost Barrier to Peritoneal Dialysis in the Developing World—An Asian Perspective , 2001, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[3]  H. Sangha,et al.  Peritoneal dialysis first: rationale. , 2011, Clinical journal of the American Society of Nephrology : CJASN.

[4]  Piya Hanvoravongchai,et al.  Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services , 2011, The Lancet.

[5]  A. Cabrita,et al.  Cost analysis of renal replacement therapy by transplant in a system of bundled payment of dialysis , 2012, Clinical transplantation.

[6]  K. Calman.  The ethics of allocation of scarce health care resources: a view from the centre. , 1994, Journal of medical ethics.

[7]  E. Borgonovi,et al.  Sustaining universal health coverage: the interaction of social, political, and economic sustainability. , 2013, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[8]  V. Kreng,et al.  The equality of resource allocation in health care under the National Health Insurance System in Taiwan. , 2011, Health policy.

[9]  G. Melnick,et al.  Funding, Coverage, and Access Under Thailand’s Universal Health Insurance Program: An Update After Ten Years , 2015, Applied Health Economics and Health Policy.

[10]  R. Yates,et al.  Arguing for universal health coverage. , 2013 .

[11]  M. Tonelli,et al.  Economic evaluation of dialysis therapies , 2014, Nature Reviews Nephrology.

[12]  V. Jha,et al.  Hemodialysis in Asia , 2015, Kidney Diseases.

[13]  Stephen Jan,et al.  How can we achieve global equity in provision of renal replacement therapy? , 2008, Bulletin of the World Health Organization.

[14]  C. Jensen,et al.  In Denmark kidney transplantation is more cost-effective than dialysis. , 2014, Danish medical journal.

[15]  M. Cowie.  National Institute for Health and Care Excellence. , 2015, European heart journal.

[16]  Eusebio M Alvaro,et al.  Understanding organ donation : applied behavioral science perspectives , 2010 .

[17]  U. Gerdtham,et al.  Economic Evaluations of Organ Transplantations - A Systematic Literature Review , 2011 .

[18]  Alan B Leichtman,et al.  US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States. , 2015, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[19]  J. Holley,et al.  Peritoneal dialysis versus hemodialysis: risks, benefits, and access issues. , 2011, Advances in chronic kidney disease.

[20]  V. Tangcharoensathien,et al.  Monitoring and Evaluating Progress towards Universal Health Coverage in Thailand , 2014, PLoS medicine.

[21]  Amit X Garg,et al.  Worldwide access to treatment for end-stage kidney disease: a systematic review , 2015, The Lancet.

[22]  Mauricio L. Barreto,et al.  Monitoring and Evaluating Progress towards Universal Health Coverage in Brazil , 2014, PLoS medicine.

[23]  Sarah Jane Marshall,et al.  Developing countries face double burden of disease. , 2004, Bulletin of the World Health Organization.

[24]  Georg Gutjahr,et al.  Cost-effectiveness analysis of renal replacement therapy in Austria. , 2011, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[25]  K. Rasanathan,et al.  What does universal health coverage mean? , 2014, The Lancet.

[26]  S. Davies.  Peritoneal dialysis—current status and future challenges , 2013, Nature Reviews Nephrology.

[27]  Shang-Jyh Hwang,et al.  Incidence, prevalence and mortality trends of dialysis end-stage renal disease in Taiwan from 1990 to 2001: the impact of national health insurance. , 2008, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[28]  W. Prodjosudjadi,et al.  End-stage renal disease in Indonesia: treatment development. , 2009, Ethnicity & disease.

[29]  Anirudh Rao,et al.  UK Renal Registry 17th Annual Report: Chapter 2 UK Renal Replacement Therapy Prevalence in 2013: National and Centre-specific Analyses , 2015, Nephron.

[30]  Universal Health Coverage in the United Kingdom , 2003, The Journal of ambulatory care management.

[31]  Xiaowen Guan,et al.  Cultures of the soul: spiritual beliefs about organ donation in China and the United States , 2010 .

[32]  E. Brown,et al.  The role of peritoneal dialysis in modern renal replacement therapy , 2013, Postgraduate Medical Journal.

[33]  W. Hörl,et al.  Healthcare systems and end-stage renal disease (ESRD) therapies--an international review: access to ESRD treatments. , 1999, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[34]  P. Roderick,et al.  UK Renal Registry 16th Annual Report: Chapter 4 Demography of Patients Waitlisted for Renal Transplantation in the UK: National and Centre-specific Analyses , 2014, Nephron Clinical Practice.

[35]  E. Brown.  Peritoneal Dialysis versus Hemodialysis in the Elderly , 1999, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[36]  J. Craig,et al.  Factors that influence the decision to be an organ donor: a systematic review of the qualitative literature. , 2012, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[37]  A. Ingsathit,et al.  A 25‐year experience of kidney transplantation in Thailand: Report from the Thai Transplant Registry , 2015, Nephrology.

[38]  W. Savedoff,et al.  Achieving Universal Health Coverage: Learning from Chile, Japan, Malaysia and Sweden , 2011 .

[39]  P. Wong,et al.  Hong Kong Renal Registry Report 2012 , 2013 .

[40]  Taslim Bb.  Identifying the Barriers to Achieving Sustainable Dialysis Programs in Sub-Saharan Africa: Nigeria as a Reference Point , 2000 .

[41]  G. Remuzzi,et al.  The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. , 2011, Kidney international.

[42]  R. Saraswathy,et al.  Economic evaluation of end stage renal disease patients undergoing hemodialysis , 2012, Journal of pharmacy & bioallied sciences.

[43]  P. Li,et al.  Development of the “Peritoneal Dialysis First” Model in Hong Kong , 2007, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[44]  T. Lim,et al.  How public and private reforms dramatically improved access to dialysis therapy in Malaysia. , 2010, Health affairs.

[45]  O. Ayodele,et al.  The global burden of chronic kidney disease and the way forward. , 2005, Ethnicity & disease.

[46]  Sharing Experience of Palliative Care , 2014 .

[47]  K. Chow,et al.  Peritoneal dialysis-first policy made successful: perspectives and actions. , 2013, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[48]  D. Wangchuk,et al.  Is diabetes and hypertension screening worthwhile in resource-limited settings? An economic evaluation based on a pilot of a Package of Essential Non-communicable disease interventions in Bhutan. , 2015, Health policy and planning.