The Effect of Outpatient Dialysis Global Budget on Medical and Drug Utilization by End-Stage Renal Disease Patients
Date Issued
2011
Date
2011
Author(s)
Tsai, Ya-Hsing
Abstract
Background: The prevalence rates of end-stage renal patients (ESRD) in Taiwan from 2002 to 2008 were highest in the world. The registered prevalence of ESRD in 2009 was 219,826 cases, health care costs spent on dialysis medical 19.66 billion NTD from 2002 to 2009 had reached 30.26 billion NTD, grew 54%. Dialysis population accounted for only 0.27% of the domestic population, dialysis costs accounted for 6.33% annual health insurance costs, medical costs of dialysis has become a heavy financial burden on health care. National Health Insurance Bureau （NHI）to control the rising medical costs, imposed an outpatient dialysis global budget (ODGB) on outpatient dialysis care. From the previous studies have shown that the implementation of ODGB but significant increase in non-dialysis outpatient medical utilization. Speculated that the implementation of global budget before dialysis patients commonly used drugs such as anti-hypertensive drugs, gastrointestinal drugs, cold medicines may be included by the dialysis provider in the dialysis services provided free of charge or paid for other health care claim.
Objective：The main purpose of this study to explore the implementation of ODGB, the impact of end-stage renal disease with hypertensive patients outpatient medical utilization and prescription drugs. Analysis of the implementation of ODGB, resulting in antihypertensive drugs in dialysis clinics to reduce prescription, free of charge, and transferred to other general outpatient prescription.
Methods: This study, using a before and after study design with a comparison group, assessed the impact of this policy innovation on outpatient and antihypertensive drugs utilization. Using a difference in difference (DID) strategy and the generalized estimating equation (GEE) approach. In order to construct the intervention group, we selected hypertensive end-stage renal disease patients from the NHI beneficiaries claim data from 2000 to 2005. Observe the number of samples for the 1,350 cases and 4,668 person-years of observation. In order to take into consideration of the phase-in implementation of the caps, we divided the study period into three stages: (1) the pre-ODGB stage (2000), (2) the adaptation stage (from 2001 to 2002), and (3) the ODGB stage (from 2003 to 2005).By propensity score (PS) matching method to choose the hypertensive non-ESRD patients in the control group. To avoid the impact of drug costs for Drug Pricing policy adjustments several times, so the end of 2003 health insurance drug list as the reference price. Calculate the annual cost of health insurance drug list to compare, And add gender, age, Charlson index, SARS, hypertention compelling indications as variables.
Findings: The regression-adjusted difference-in-difference estimates revealed that the implementation of ODGB was followed by a significant increase in number of non-dialysis outpatient visit for hypertensive ESRD patients by 3.86 visits per person per year, and the number of antihypertensive drugs prescribed in non-dialysis outpatient visit by 4.05 visits per person per year, and the relative drug cost of antihypertensive drugs was also more than 767.33 per person per year,
relative to the change of hypertensive non-ESRD patients during this period. Comorbidity severity (Charlson Index) higher, the greater the age (50 years), the more will increase the general out-patient visits and the use of antihypertensive drugs. SARS period were significantly reduced the utilization, in addition to the dialysis clinic also observed the anti-hypertensive drugs significantly reduced the relative drug cost.
Implementation of ODGB, the dialysis clinics of non-dialysis treatment to reduce the cost of antihypertensive drugs, but the total amount transferred to another increase in the general outpatient medical care utilization and expenditures on drugs instead of adding more. Exclusion of other medical resource utilization. The above, this study suggests a local range of global budget system, health care providers must take into account the self-interested behavior may result in containing health care system over to the other global budget, pre-assessment package of measures to avoid increasing the overall medical care utilization and costs of medicines; or consider further expansion of global budget range of services, providing the same outpatient dialysis services, but also non-dialysis prescription drugs, so patients can reduce the frequency to visit the doctor, more convenient medical care to patients and improve the overall health care resource utilization.
Subjects
outpatient dialysis global budget
ESRD
dialysis
propensity score
GEE
Type
thesis
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