Bellizzi Vincenzo, Perrone Francesco, Terracciano Vincenzo, Cucciniello Emanuele, Stanzione Giovanna, D'Angiò Pierluigi, De Nicola Luca, Di Iorio Biagio
Nephrology Division, "A. Landolfi" Hospital, Solofra - Italy.
J Nephrol. 2008 Nov-Dec;21(6):894-9.
Chronic dialysis exposes patients to several procedures that may influence lifestyle and quality of life. These hidden costs, however, have never been evaluated.
To compare the costs related to diagnostic and therapeutic procedures between not-for-profit (nFP) and for-profit (FP) dialysis care systems, we mailed to Italian nephrology units a questionnaire on modalities of medical prescriptions and reservations, waiting time for tests and modalities of drugs distribution.
247 centers (42%) replied to the questionnaire: 177 nFP (72%) and 70 FP (28%). The response rate was 54% of nFP and 26% of FP centers. All centers provided hemodialysis (in satellite units, 42% nFP and 14% FP, p<0.001; at home, 23% nFP and 1% FP, p<0.001). Peritoneal dialysis was offered by 60% nFP and 6% FP (p<0.001). Centers provided dialysis care for 15,294 patients, 85% in nFP and 15% in FP. At least 1 general practitioner prescription for dialysis, diagnostic tests, specialist consultations and drugs, was requested to patients in 50% of nFP and 95% of FP centers (p<0.001). Reservations for tests and specialist visits were made by patients in 6% of nFP and 20% of FP centers (p<0.001). In nFP and FP centers, waiting time for tests was 2 vs. 4 days for lung x-ray (p<0.01), 7 vs. 11 days for gastroscopy (p<0.05) and 14 vs. 13 days for echocardiography (NS). Erythropoietin, phosphate binders and nutritional supplements, were supplied by patients in 7%, 46% and 37% of nFP centers, and 86%, 86% and 90% of FP centers (p<0.001).
The dialysis care system charges patients a high hidden cost, represented by procedures related to dialysis. Higher costs and reduced choice of treatment modalities may characterize the for-profit dialysis system.
长期透析使患者面临多种可能影响生活方式和生活质量的医疗程序。然而，这些隐性成本从未得到评估。
为比较非营利性（nFP）和营利性（FP）透析护理系统在诊断和治疗程序方面的成本，我们向意大利肾脏病科单位邮寄了一份关于医疗处方和预约方式、检查等待时间以及药物分发方式的问卷。
247个中心（42%）回复了问卷：177个非营利性中心（72%）和70个营利性中心（28%）。非营利性中心的回复率为54%，营利性中心为26%。所有中心均提供血液透析（在卫星单位进行的，非营利性中心占42%，营利性中心占14%，p<0.001；在家中进行的，非营利性中心占23%，营利性中心占1%，p<0.001）。60%的非营利性中心提供腹膜透析，营利性中心为6%（p<0.001）。各中心为15294名患者提供透析护理，其中85%在非营利性中心，15%在营利性中心。50%的非营利性中心和95%的营利性中心要求患者至少开具1份用于透析、诊断检查、专家会诊和药物的全科医生处方（p<0.001）。6%的非营利性中心和20%的营利性中心患者进行了检查和专家门诊预约（p<0.001）。在非营利性和营利性中心，肺部X光检查的等待时间分别为2天和4天（p<0.01），胃镜检查为7天和11天（p<0.05），超声心动图检查为14天和13天（无显著差异）。7%、46%和37%的非营利性中心患者自行提供促红细胞生成素、磷结合剂和营养补充剂，而营利性中心这一比例分别为86%、86%和90%（p<0.001）。
透析护理系统向患者收取与透析相关程序所代表的高额隐性成本。更高的成本和治疗方式选择的减少可能是非营利性透析系统的特点。
