The hidden financial catastrophe of chronic kidney disease under universal coverage and Thai “Peritoneal Dialysis First Policy”
Issued Date
2022-10-13
Resource Type
eISSN
22962565
Scopus ID
2-s2.0-85140730613
Pubmed ID
36311589
Journal Title
Frontiers in Public Health
Volume
10
Rights Holder(s)
SCOPUS
Bibliographic Citation
Frontiers in Public Health Vol.10 (2022)
Suggested Citation
Sangthawan P., Klyprayong P., Geater S.L., Tanvejsilp P., Anutrakulchai S., Boongird S., Gojaseni P., Kuhiran C., Lorvinitnun P., Noppakun K., Parapiboon W., Sirilak S., Tankee P., Taruangsri P., Sangsupawanich P., Sritara P., Chaiyakunapruk N., Kitiyakara C. The hidden financial catastrophe of chronic kidney disease under universal coverage and Thai “Peritoneal Dialysis First Policy”. Frontiers in Public Health Vol.10 (2022). doi:10.3389/fpubh.2022.965808 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85452
Title
The hidden financial catastrophe of chronic kidney disease under universal coverage and Thai “Peritoneal Dialysis First Policy”
Author's Affiliation
Faculty of Medicine, Chiang Mai University
Nakornping Hospital
Faculty of Medicine, Khon Kaen University
Faculty of Medicine, Prince of Songkia University
Bhumibol Adulyadej Hospital
Naresuan University
Faculty of Medicine Ramathibodi Hospital, Mahidol University
VA Medical Center
Maharaj Nakhon Ratchasima Hospital
University of Utah Health
Prince of Songkla University
Vachiraphuket Hospital
Sunpasitthiprasong Hospital
Somdej Pranangchao Sirikit Hospital
Nakornping Hospital
Faculty of Medicine, Khon Kaen University
Faculty of Medicine, Prince of Songkia University
Bhumibol Adulyadej Hospital
Naresuan University
Faculty of Medicine Ramathibodi Hospital, Mahidol University
VA Medical Center
Maharaj Nakhon Ratchasima Hospital
University of Utah Health
Prince of Songkla University
Vachiraphuket Hospital
Sunpasitthiprasong Hospital
Somdej Pranangchao Sirikit Hospital
Other Contributor(s)
Abstract
Objective: Universal health coverage can decrease the magnitude of the individual patient's financial burden of chronic kidney disease (CKD), but the residual financial hardship from the patients' perspective has not been well-studied in low and middle-income countries (LMICs). This study aimed to evaluate the residual financial burden in patients with CKD stage 3 to dialysis in the “PD First Policy” under Universal Coverage Scheme (UCS) in Thailand. Methods: This multicenter nationwide cross-sectional study in Thailand enrolled 1,224 patients with pre-dialysis CKD, hemodialysis (HD), and peritoneal dialysis (PD) covered by UCS and other health schemes for employees and civil servants. We interviewed patients to estimate the proportion with catastrophic health expenditure (CHE) and medical impoverishment. The risk factors associated with CHE were analyzed by multivariable logistic regression. Results: Under UCS, the total out-of-pocket expenditure in HD was over two times higher than PD and nearly six times higher than CKD stages 3–4. HD suffered significantly more CHE and medical impoverishment than PD and pre-dialysis CKD [CHE: 8.5, 9.3, 19.5, 50.0% (p < 0.001) and medical impoverishment: 8.0, 3.1, 11.5, 31.6% (p < 0.001) for CKD Stages 3–4, Stage 5, PD, and HD, respectively]. In the poorest quintile of UCS, medical impoverishment was present in all HD and two-thirds of PD patients. Travel cost was the main driver of CHE in HD. In UCS, the adjusted risk of CHE increased in PD and HD (OR: 3.5 and 16.3, respectively) compared to CKD stage 3. Conclusions: Despite universal coverage, the residual financial burden remained high in patients with kidney failure. CHE was considerably lower in PD than HD, although the rates remained alarmingly high in the poor. The “PD First' program” could serve as a model for other LMICs. However, strategies to minimize financial distress should be further developed, especially for the poor.