NHSB gives nod to reimbursement payment for kidney patients opting for HD
 
The National Health Security Board (NHSB) had on Jan 6, 2022 endorsed a proposal to reimburse patients with chronic kidney failure who opt for hemodialysis (HD) instead of peritoneal dialysis (PD), effective Feb 1, 2022.
 
Peritoneal dialysis is a type of dialysis which uses the peritoneum in a person's abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood.

Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidneys are not working normally.
 
This reimbursement proposal came from opinions compiled during the past visits to healthcare units treating patients with chronic kidney failure, said Deputy Prime Minister and Public Health Minister Anutin Charnvirakul, in his capacity as the chairman of the NHSB.

Before this endorsed proposal takes effect, those kidney patients choosing HD over PD are normally charged 1,500 baht per time of the kidney dialysis, said Mr Anutin.
 

After having discussed with Dr Jadej Thammatacharee, secretary-general of the National Health Security Office (NHSO) about the possibility of helping these patients to cope with the financial burden associated with HD, he said, it was concluded that the solution should be to reimburse these patients for their costs of HD.
 
The reimbursement proposal was based on the Universal Coverage Scheme’s (UCS) core principle -- to as much as possible cover necessary healthcare costs for patients under the UCS in order to save them from plunging into financial difficulties as a result of paying their healthcare costs out of their own pocket, said Dr Jadej.
 
More importantly, the patient-centred care principle is also adopted in this reimbursement proposal as kidney patients will be allowed to together with their doctors choose the type of renal dialysis most suitable for them considering their financial status, disease and other social factors, he said.
 
One important factor that also needs to think about when making such a decision is those indirect costs which may come with HD including the cost of travelling regularly to and from a healthcare unit for kidney dialysis.
 
Aside from proposing to waive the HD fee for these patients, the NHSO also proposed to negotiate with parties concerned for more bargains in the costs of providing HD services in order to keep the costs as low as possible while the UCS has to increase the number of HD units and require more staff as more kidney patients are expected to switch from PD to HD, he said.
 
An additional mechanism is also required to prevent the number of patients shifting from PD to HD to rise so rapidly that overwhelm the healthcare system, while the work to curb the number of new kidney patients needs to be accelerated, he said.
 

There currently are 24,256 kidney patients receiving HD whose treatment is paid by the UCS, while the other 6,546 patients aren’t willing to undergo PD and have chosen to pay for the costs of HD by themselves, said Dr Jakkrit Ngowsiri, deputy secretary-general of the NHSO.

Altogether, a total of 30,802 kidney patients are receiving HD under the UCS, while another 32,892 patients do PD, he said.
 
Of these 32,892 patients undergoing PD, only about 27,958 tend to be willing to continue with PD as the rest are likely to shift to HD later when they will no longer have to pay for the HD fee, he said.
 
At present, the NHSO reimburses a healthcare unit offering the HD service at 197,700 baht per patient per year, while the cost of PD is 227,300 baht per patient per year, he said.
As of now, the total reimbursement for both HD and PD under the UCS is 12.27 billion baht per year, he said.
 
However, he said, when HD is covered for those patients choosing HD over PD, the total budget required for funding the UCS’ kidney dialysis programme will therefore become 13.41 billion baht per year, a 1.14-billion-baht increase.
 
However, when the budget already set aside for paying the cost of Erythropoietin (EPO) is deducted from the 1.14-billion-baht increase, the actual extra budget required for funding the HD reimbursement programme will then become 1.07 billion baht, he said.
 
But since the implementation of this reimbursement programme will run from February until September in this 2022 fiscal year, or in only eight months, the exact additional budget needed will become 719.9 million baht for this fiscal year, he said.
 
The NHSO, meanwhile, has 968.32 million baht left from the 2021fiscal year, 238.59 million baht of which are set aside for financing the inclusion of new five healthcare benefits into the UCS’s core benefit package, he said.
 
In this regard, a total of 729.73 million baht are available for use, which is sufficient for funding the 719.9-million-baht increase in funds required in the next eight months for the HD reimbursement programme, he said.
 
Actually there will still be 9.83 million baht left after the 719.9 million baht is taken, he said.

The main reason that has led the NHSB to approve the proposal to reimburse kidney patients with end-stage renal disease for HD costs is the need to improve flexibility and offer them more choices to choose from in the UCS’ kidney dialysis programme.
 
The necessity of offering HD to the patients who want it for the sake of maintaining the UCS’s service quality as well as the importance of patient-centred care were also taken into consideration when the NHSB decided on the reimbursement proposal.
 
Kidney patients will be allowed to, together with their doctors, make the decision as to whether they should go for HD or not.
 
And to ensure the HD reimbursement programme will be fully funded in the next fiscal year, the NHSO will ensure sufficient budget will be set aside specifically for funding this programme, said Mr Anutin.

The budget diverted to fund the reimbursement programme for kidney patients in the 2022 fiscal year actually was the budget left from the previous fiscal year, he said.
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