Need for an incentive-based reimbursement policy toward quality care for dialysis patient management

Need for an incentive-based reimbursement policy toward quality care for dialysis patient management.BackgroundIn view of the growing dialysis population and the increasing reimbursement cost in the industrialized countries, a critical evaluation of the dialysis economy is warranted.MethodsData for the reimbursement and dialysis patients' statistics were collected from the National Medical Care Expenditure (NMCE), 1979–1996, which was published by the Japanese government, and the article “An overview of regular dialysis treatment in Japan,” 1979–1998, by the Japanese Society for Dialysis Therapy, as well as unpublished data from the Yokohama Dai-ichi Hospital and 10 affiliated urban dialysis centers.ResultsFrom 1979 to 1996, the dialysis population increased 5.2 times and the NMCE increased 2.5 times, whereas the end-stage renal disease (ESRD) payment increased only 1.8 times. Because of a drastic reduction in the dialyzer cost and the dialysis-related technical fee, both the percentage of ESRD-related payment within NMCE and ESRD payment per capita per year decreased from 5.4 to 4.1% and from 16.3 million yen to 5.6 million yen, respectively. Despite this drastic cost reduction, the patient survival and quality of life determined by the social rehabilitation rate did not decline.ConclusionThe Japanese health insurance policy for dialysis management achieved a successful cost cut during the 1979–1996 period by using an incentive-based payment system toward quality care. However, the forthcoming further exponential increase in the dialysis population may put the dialysis economy and hence dialysis care quality in jeopardy. Effort must be made to reduce the ESRD-related cost through prevention of the progression of kidney diseases, propagation of renal transplantation, and internationalization of continuous ambulatory peritoneal dialysis and erythropoietin cost. A reduction in dialysis reimbursement, if necessary, must be achieved through an incentive-based system toward quality patient care

Dialysis and Quality of Dialysate in Southeast Asian Developing Countries

Background: The number of dialysis patients has been increasing in Southeast Asia, but statistical data about these patients and on the quality of dialysates in Southeast Asian dialysis facilities are still imprecise. For this study, dialysis-related statistical data were collected in Southeast Asia. Methods: A survey of the quality of dialysates was carried out at 4 dialysis facilities in Vietnam and Cambodia. The dialysis patient survey included the numbers of dialysis facilities and patients receiving dialysis, a ranking of underlying diseases causing the initiation of dialysis, the number of patients receiving hemodialysis (HD)/on-line hemodiafiltration/continuous ambulatory peritoneal dialysis, the number of HD monitoring devices installed, the cost of each session of dialysis (in USD), the percentage of out-of-pocket payments, and the 1-year survival rates of the dialysis patients (in percent). The dialysate survey covered the endotoxin (ET) level and bacterial count in tap water, in water filtered through a reverse osmosis system and in dialysate. Results: In each of the countries, the most frequent reason for the initiation of dialysis is diabetes mellitus. HD is usually carried out according to the ‘reuse' principle. The 1-year survival rates are 70% in Myanmar and about 90% in the Philippines and Malaysia. The ET levels in standard dialysates were satisfactory at 2 facilities. The bacterial counts in dialysates were not acceptable at any of the facilities investigated. Conclusion: There is an urgent need to teach medical workers involved in dialysis how to prepare sterile and ET-free dialysates

Multiple HLA-matched platelet transfusions for a single patient with broad anti-HLA antibodies: a case report

The efficacy of 30 platelet concentrate (PC) products transfused to a patient with myelodysplastic syndrome (MDS) was evaluated by calculating the 1-hour post-transfusion corrected count increment (1h-CCI). Of the 30 transfusions, all HLA-A/B-matched, the cross-match (CM) test was negative in 23 (CM(-)-PC) and weakly positive (CM(+)-PC) in 2, and the CM test was not conducted in 5 (non-CM-PC). The effective rate was higher with CM(-)-PC compared to non-CM-PC (82.6% vs 60%), but statistical significance was not achieved, which suggested that the CM test of PC may still be a not satisfactorily effective predictor of PC refractoriness. Studies are ongoing in Japan to confirm on the importance of CM test of PC