Praditpornsilpa Kearkiat, Lekhyananda Sookruetai, Premasathian Nalinee, Kingwatanakul Pornchai, Lumpaopong Adisorn, Gojaseni Pongsathorn, Sakulsaengprapha Amporn, Prasithsirikul Wisit, Phakdeekitcharoen Bunyong, Lelamali Kumthorn, Teepprasan Tavichai, Aumanaphong Chatsuda, Leerawat Benjaporn, Pongpiyadej Jintana, Srangsomvong Soysaang, Kanjanabuch Talerngsak, Eiam-Ong Somchai, Vareesaengthip Kriengsak, Lumlertkul Dusit
The Nephrology Society of Thailand, Bangkok, Thailand.
J Med Assoc Thai. 2011 Sep;94 Suppl 4:S1-6.
The national health insurance fund in Thailand initiated by the national health security act in November, 2002. In October 2007, the national health insurance fund launched the first renal replacement therapy (RRT) reimbursement plan by the "Peritoneal Dialysis-First" (PD First) policy. The rationale of the PD First Policy resulted from the perspective that PD for end stage renal disease (ESRD) treatment offers the most economic and efficient outcome. The present study was conducted to determine whether the increase of RRT penetration by national health policy could impact the national RRT prevalence.
The Thailand Renal Replacement Therapy (TRT) database in 2007, 2008, and 2009 were retrieved and analyzed.
By TRT registry data, the total yearly prevalence of RRT increased by an average of 14.8% after the implementation of national health insurance and the "PD First" policy from 2007 to 2009. The total yearly prevalence of hemodialaysis (HD) modestly increased (14.7%) while the total yearly prevalence of PD remarkably expanded by 107.3%. The yearly incidence of all RRT modalities increased by an average of 34.8% in 2007 to 2009. The yearly incidence of HD modestly increased (8.1%) while the total yearly incidence of PD remarkably elevated by 157.8%. Civil Servants Medical Benefit Compensation (CSMBS) was the major funding source of RRT cases (34.5%) while national health insurance funding was the second major funding source (26.0%). From 2007-2009, the CSMBS funding was the majority of HD while national health insurance funding was the majority of PD. The sharing of PD by national health insurance increased from 33.9% in 2007, 58.6% in 2208, and 77.2% in 2009.
The coverage ofESRD patients by national health insurance fund by the "PD First" policy impacted the RRT prevalence and incidence both the total prevalence and total incidence due to the universal penetration to RRT treatment of Thai population. Also, the policy altered the RRT modality predisposition. PD modality willfinally be the majority ofThaiRRT modalities if the policy can be managed successfully.
泰国国家健康保险基金由2002年11月的《国家健康保障法案》发起。2007年10月，国家健康保险基金通过“优先腹膜透析”（PD优先）政策推出了首个肾脏替代治疗（RRT）报销计划。PD优先政策的基本原理源于这样一种观点，即终末期肾病（ESRD）治疗中的腹膜透析提供了最经济有效的结果。本研究旨在确定国家卫生政策导致的RRT普及率提高是否会影响全国RRT患病率。
检索并分析了2007年、2008年和2009年的泰国肾脏替代治疗（TRT）数据库。
根据TRT登记数据，2007年至2009年实施国家健康保险和“PD优先”政策后，RRT的年度总患病率平均增加了14.8%。血液透析（HD）的年度总患病率略有增加（14.7%），而腹膜透析的年度总患病率显著增长了107.3%。2007年至2009年，所有RRT模式的年发病率平均增加了34.8%。HD的年发病率略有增加（8.1%），而腹膜透析的年总发病率显著上升了157.8%。公务员医疗福利补偿（CSMBS）是RRT病例的主要资金来源（34.5%），而国家健康保险资金是第二大资金来源（26.0%）。2007 - 2009年，CSMBS资金是HD的主要来源，而国家健康保险资金是PD的主要来源。国家健康保险对PD的分担比例从2007年的33.9%、2008年的58.6%增加到2009年的77.2%。
国家健康保险基金通过“PD优先”政策对ESRD患者的覆盖影响了RRT的患病率和发病率，包括总患病率和总发病率，这是由于泰国人口对RRT治疗的普遍普及。此外，该政策改变了RRT模式的倾向。如果该政策能够成功实施，腹膜透析模式最终将成为泰国RRT模式的主流。
