https://scholars.lib.ntu.edu.tw/handle/123456789/635871
標題: | Impact of dialysis reimbursement policies on care outcomes in peritoneal dialysis patients in Taiwan | 作者: | RAY-E CHANG Lin, Shih-Pi Myrtle, Robert C |
關鍵字: | Competing risks; Implementation management; Peritoneal dialysis; Reimbursement incentives; Unintended policy impacts | 公開日期: | 六月-2023 | 出版社: | Elsevier Ltd | 卷: | 132 | 來源出版物: | Health Policy | 摘要: | The number of treated end stage renal disease (ESRD) patients worldwide has rapidly grown. To prolong their lives ESRD patients require transplantation or dialysis treatment. Limited donor availability has caused most of the ESRD patients to rely on either hemodialysis (HD) or peritoneal dialysis (PD). Taiwan had the highest prevalence rate worldwide and sought to increase the PD utilization through a series of reimbursement incentives. This study evaluated the effect of those policy initiatives. A retrospective longitudinal study using a before-and-after analysis was conducted. ESRD patients initiating either PD or HD were identified from the entire population of Taiwan NHI's beneficiaries. PD patients, before and after the PD-encouraging initiatives, were matched through a propensity score technique, and the change in PD technical failure was analyzed. HD patients were also matched as the control group to assess the impact on PD mortality. The competing risk regression approach for survival analysis was adopted. The results indicate the increase in PD utilization during this period was also accompanied by increases in both technique failure and mortality. Since PD shifts more burden of care to patients, efforts to increase its utilization may require an increase in the education of providers and patients to benefit more effectively. It may also require an increase in staff to provide ongoing training and support as the policy unfolds. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/635871 | ISSN: | 01688510 | DOI: | 10.1016/j.healthpol.2023.104816 |
顯示於: | 健康政策與管理研究所 |
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