New HD cost reimbursement policy will ease heavy burden on kidney patients
 
For those who are living with chronic kidney failure and require hemodialysis (HD) two to three times a week, the cost of purifying the blood and other related costs are estimated to be almost 20,000 baht per person per month, according to the information from Phuean Rok Tai (Nephrology Friends), an association of patients with kidney disease.
 
That is quite a heavy burden for any middle and low income families, particularly during this sluggish economic situation, said Thanaphon Dokkaeo, president of the association.
 
The decision by the National Health Security Board (NHSB) to reimburse patients with chronic kidney failure opting for HD instead of peritoneal dialysis (PD), effective Feb 1, 2022, therefore came as excellent news to all kidney patients, he said.
 
On behalf of all kidney patients, He expressed their gratitude for this decision by Deputy Prime Minister and Minister of Public Health Anutin Charnvirakul and the NHSB, which is absolutely in line with the patient-centred care principle.
 
His concern, however, remains about the readiness of the HD service system to accommodate this additional health benefit for kidney patients, which he said will need to be closely monitored and assessed.
 
There should not be a problem in large cities as both state- and private-run hospitals are believed to have sufficient resources to support the implementation of this new policy, said Dr Suchai Sritippayawan, secretary-general of Nephrology Society of Thailand (NST).
 
It is estimated that there will be about 15,000 kidney patients needing and choosing HD over PD in the first year of the implementation of this new policy, he said.
 
Of this number, about 6,000 people will be those patients who had already chosen HD, although that meant they had to pay for the cost of HD on their own, while three-fourths of the about 8,000 patients newly diagnosed to have chronic kidney failure andneeding kidney dialysis, or about 5,000, will also choose HD over PD, he said.
 
The rest will be those who previously underwent PD regularly and now want to shift to HD as they will now be reimbursed for the cost of HD, he said.
 
Considering this number of patients choosing or requiring HD, allowing them to choose HD or PD won’t likely become a problem in this short term, he said.
 
“The availability of HD facilities and staff is unlikely to become a huge problem in the beginning as PD can still be an option in case a number of patients still have to be put on the waiting list for HD,” he said.
 
And now that the cost of automated peritoneal dialysis (APD), a form of PD performed using a PD machine typically at night whilst the patient is sleeping, is covered for under the National Health Security Office’s (NHSO) Universal Coverage Scheme (UCS), many patients never want to return HD, he said.
 
Before the arrival of APD, patients were normally required to do PD three to four times a day, he said.
 
In a long term, when a higher number of new HD units will be opened in more small hospitals, he said, he is concerned that that will eventually lead to shortage of medical specialists needed for operating these new HD units.
 
So, in preparation for the foreseen growing demand for these specially-trained healthcare workers – namely nephrologists, vascular surgeons and nephrology nurses – the Ministry of Public Health is therefore being encouraged to begin training and hiring more of these professionals, he said.
 
The NST will be cooperating with the ministry in accelerating the training of these three types of healthcare professionals needed to ensure there will be enough of them by the time the demand for them rises rapidly, he said.
 
Dr Suchai’s other concern is the quality control of HD centres after the NHSO had previously indicated that the HD service quality inspection by the sub-committee on treatment quality certification, which was normally required upon requesting reimbursement for HD costs, would no longer be necessary.
 
Although the NHSO has insisted it now has treatment quality inspection teams to take over the job from the sub-committee, Dr Suchai said, he still believes it will be best for the NHSO and all other medical professional associations concerned to further discuss the matter and find the best solution.
 
As for its part, the NST now aims to train staff at existing HD centres on how to provide advice to kidney patients as to what will be most suitable for them when it comes to choosing kidney dialysis, he said.
 
Patients should be informed properly about both advantages and disadvantages of each type of kidney dialysis, in order to help them make the right decision in choosing the type of kidney dialysis that is most suitable for them, he said.
 
He suggested that the NHSO should require every kidney patient to sign a document to acknowledge that they have been provided with sufficient advice before choosing any types of kidney dialysis.
 
Kidney patients and their doctors will together decide what type of kidney dialysis is most suitable for each them in terms of such as lifestyle and their living environment, said Assoc Prof Dr Surasak Kantachuvesiri, president of the NST.
 
Previously when PD was designated as the first option, many of those kidney patients who felt they weren’t really ready to do PD at home and were afraid of possible infections had to pay for their decisions to choose HD over PD, he said.
 
“Over a decade ago, we had launched the PD First policy because there weren’t sufficient HD units and staff to serve all patients at the same time. So they weren’t allowed to choose HD over PD back then,” he said.
 
“The burden of having to pay for HD services on their own was enormous indeed for many patients,” he said.
 
And since HD is now made a choice for kidney patients under the UCS, training enough healthcare professionals required to operate more HD centres to come will be the key factor to succeed in the implementation of this new policy, he said.
 
Opening a new HD centre may not take much time but training these healthcare professionals specifically to keep up with the growing demand for them at new HD centres does take time, he said.
 
After all, he said, he actually expects the transition from PD to HD to be very gradual, especially in remote areas where there still aren’t HD units to serve those patients interested in shifting from PD to HD.
 
Those kidney patients who already have chosen HD over PD and pay for its costs out of their own pocket will be the very first group to immediately benefit from this change in the HD cost reimbursing policy, he said.
 
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