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Health policy
Research
Health policies on dialysis modality selection: a nationwide population cohort study
  1. Yi-Chun Lin1,2,
  2. Yen-Chung Lin3,4,
  3. Chih-Chin Kao3,4,
  4. Hsi-Hsien Chen3,4,
  5. Chih-Cheng Hsu5,
  6. Mai-Szu Wu3,4
  1. 1Division of Endocrinology & Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  2. 2Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
  3. 3Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
  4. 4Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  5. 5Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
  1. Correspondence to Dr Mai-Szu Wu; maiszuwu{at}gmail.com or Dr Yen-Chung Lin; yclin0229{at}tmu.edu.tw

Abstract

Objectives In Taiwan, peritoneal dialysis (PD) and haemodialysis are fully accessible to patients with end-stage renal disease. However, the usage of PD is considered low in Taiwan. Since 2005, 4 major policies have been implemented by Taiwan's Ministry of Health and Welfare, namely a multidisciplinary predialysis care programme and usage increasing the PD incidence as a key performance indicator (KPI) for hospital accreditation, both of which were implemented in 2006; reimbursement of the glucose-free dialysate, icodextrin that was implemented in 2007; and insurance reimbursement for renting automated PD machines that was implemented in 2008. The aim of this study was to analyse the associations between the PD promotional policies and the actual PD selection rates.

Setting We analysed data within the Taiwan Renal Registry Data System from 2006 to 2013, focusing on the PD incidence in relation to the timings of the 4 PD promotional policies; then we stratified the results according to age, sex and the presence of diabetes mellitus.

Participants From 2006 to 2013, 115 565 patients were enrolled in this study. The mean (SD) age of patients on PD was 54.6 (15.7) years.

Results During the time frame in which the 4 PD promotional policies were implemented, the PD incidence increased from 12.8% in 2006 to 15.1% in 2009. The PD incidence started to decline in 2010 (13.8%) when the hospital accreditation policy was repealed. The 3 remaining policies were weakly associated with the PD incidence. The observational analysis determined that the patients' ages, sexes and diabetes mellitus incidence rates were relatively stable from 2006 to 2013.

Conclusions Of the 4 health policies intended to promote PD usage, using increasing the PD incidence as a KPI for hospital accreditation had the strongest association with the PD incidence.

  • Accreditations
  • Health policies
  • Peritoneal dialysis
  • Health insurance reimbursement
  • End Stage Renal Disease

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-013007

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    Footnotes

    • Contributors Yi-CL, Ye-CL and M-SW conceived and designed the experiments; Yi-CL performed the experiments; Ye-CL and C-CH analysed the data; Yi-CL, H-HC and C-CK contributed reagents/materials/analysis tools; Yi-CL and M-SW wrote the manuscript.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval Taipei Medical University Institutional Review Board Ethics Committee (No. 201405054).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.