Risk factor and cost accounting analysis for dialysis patients in Taiwan

Abstract

According to the 2004 US Renal Data System's annual report, the incidence rate of chronic renal failure in Taiwan increased from 120 to 352 per million populations between 1990 and 2003. This incidence rate is the highest in the world. The prevalence rate, which ranks number two in the world (Japan ranks number one), also increased from 384 to 1630 per million populations. Based on 2005 Taiwan national statistics, there were 52,958 end-stage renal disease (ESRD) patients receiving routine dialysis treatment. This number, which comprised less than 0.2% of the total population and consumed $2.6 billion New Taiwan dollars, was more than 6.12% of the total annual spending of national health insurance during 2005. Dialysis expenditures for patients with ESRD rank the highest among all major injuries (traumas) and diseases. This article identifies and discusses the risk factors associated with consumption of medical resources during dialysis. Instead of using reimbursement data to estimate cost, as seen in previous studies, this study uses cost data within organizations and focuses on evaluating and predicting the resource consumption pattern for dialysis patients with different risk factors. Multiple regression analysis was used to identify 23 risk factors for routine dialysis patients. Of these risk factors, six were associated with the increase of dialysis cost: age (i.e. 75 years old and older), liver function disorder, hypertension, bile-duct disorder, cancer and high blood lipids. Patients with liver function disorder incurred much higher costs for injection medication and supplies. Hypertensive patients incurred higher costs for injection medication, supplies and oral medication. Patients with bile-duct disorder incurred a significant difference in check-up costs (i.e. costs were higher for those aged 75 years and older than those who were younger than 30 years of age). Cancer patients also incurred significant differences in cost of medical supplies. Patients with high blood lipids incurred significant differences in cost of oral medication. This study identified the relationship between cost and risk factors of dialysis procedures for ESRD patients based on average variable costs for each dialysis treatment. The results show that certain risk factors (e.g. aged 75 and older, hypertension, bile-duct disease, cancer and high blood lipids) are associated with higher cost. The results from this study could enable health policy makers and the National Health Insurance Bureau to design a fairer and more convincible reimbursement system for dialysis procedures. This study also provides a better understanding of what risk factors play more influential roles in affecting ESRD patients to receive haemodialysis treatment. It will help policy makers and health-care providers in better control or even prevent the disease and manage the distribution of the treatment. In addition, with the results from the analysis of cost information, we can tell which risk factors have more impacts on the dialysis cost. It will further hel...

Increasing home‐based dialysis therapies to tackle dialysis burden around the world: A position statement on dialysis economics from the 2nd Congress of the International Society for Hemodialysis

“…In the United States, the ESRD program was cost at US$22.7 billion in 2006, accounting for 6.4% of the total Medicare expenditure for about 1.2% of all Medicare patients. In 2005 in Taiwan, which has one of the highest ESRD prevalence rates in the world, dialysis patients consumed >6.1% of the total annual spending of national health insurance 10 . In Korea, although the number of dialysis patients only accounts for 0.12% of the total patient population, the cost of dialysis consumes 3% of the total medical costs.…”

“…In Taiwan and Korea, for example, under public provision of health care, 91.5% and 80% of their ESRD patients are being treated by HD. Of note is that in 2005, there were 52,958 ESRD patients receiving routine dialysis treatment in Taiwan which comprised less than 0.2% of the total population and consumed more than 6.12% of the total annual spending of national health insurance 10 . In Hong Kong, the annual maintenance cost for CAPD was US$12,800, while for in‐center HD the figure was US$30,600 8 .…”

Increasing home based dialysis therapies to tackle dialysis burden around the world: A position statement on dialysis economics from the 2nd Congress of the International Society for Hemodialysis

“…In the USA, the ESRD program was cost at US$22.7 billion in 2006, accounting for 6.4% of the total Medicare expenditure for about 1.2% of all Medicare patients. In 2005 in Taiwan, which has one of the highest ESRD prevalence rates in the world, dialysis patients consumed more than 6.1% of the total annual spending of national health insurance 10 . In Korea, although the number of dialysis patients only accounts for 0.12% of the total patient population, the cost of dialysis consumes 3% of the total medical costs.…”

“…In Taiwan and Korea, for example, under public provision of healthcare, 91.5% and 80% of their ESRD patients are being treated by hemodialysis. Of note is that in 2005, there were 52,958 ESRD patients receiving routine dialysis treatment in Taiwan which comprised less than 0.2% of the total population and consumed more than 6.12% of the total annual spending of national health insurance 10 . In Hong Kong, the annual maintenance cost for CAPD was US$12 800, whilst for in‐centre HD the figure was US$ 30 600 8 .…”

“…In 2005 in Taiwan, which has one of the highest ESRD prevalence rates in the world, dialysis patients consumed more than 6.1% of the total annual spending of national health insurance. 10 In Korea, although the number of dialysis patients only accounts for 0.12% of the total patient population, the cost of dialysis consumes 3% of the total medical costs. Similarly, the renal services account for about 1% of the federal health budget in Malaysia.…”