| Summary: | 碩士 === 國立臺灣大學 === 公共衛生碩士學位學程 === 101 === Background: With population aging and the prevalence of chronic diseases like diabetes, the number of people with chronic kidney disease (CKD) has increased annually. As an example, the incidence and prevalence rates of end stage renal disease (ESRD) in Taiwan since 2001 has been the highest in the world. Since kidney diseases in Taiwan are still mainly handled using dialysis treatment, with the increase in the number of people receiving this treatment, expenditures for dialysis have become a huge burden on the National Health Insurance’s (NHI) budget. It has therefore become an important responsibility for the health authorities to find other ways of treatment to reduce the financial strain. Although several studies have found peritoneal dialysis (PD) to be cost-effective, and a series of policies have also been implemented to encourage PD treatment since 2005, a number of studies here and abroad have pointed out that the medical costs of patients changing dialysis modality in the first year are higher than those who have not changed modality at all. This study will investigate the circumstances before and after ESRD patients are encouraged to receive PD treatment and the change of condition of PD patients within one year of technique failure from the perspective of the patient and the medical institution offering such treatment, in order to gain understanding of the changes brought about by technique failure after policy implementation by the government.
Methods：Retrospective secondary data analysis is employed using NHI data from 2003 to 2009. Records from January 2004 to December 2008 of incident PD patients were collected to investigate patient conditions within one year of technique failure. Technique failure here is defined as including death and change of treatment to hemodialysis. Statistical analysis includes ANOVA, Chi-square test, and Logistic Regression Analysis to examine the correlation between the dialysis treatment policy and technique failure. by PD.
Findings: The results show that failure rate was 14.29% before policy implementation, while post-implementation failure rate was 16.19%. Adjustments were made to control sex, age, class of hospital, and whether the patient had diabetes, and the statistical analysis showed that the policy intervention involved a significant difference on technique failure (p=0.0299). The risks of technique failure after policy intervention increased by 1.374 Moreover, the risk of failure treatment at center size<25 is 1.459 times higher than that at >100 centers. The risk also increases with age; the risk for patients over 75 years old is 8.471 times higher than that of patients within the age range of 20-44.
To face with rapidly escalating healthcare costs associated with ESRD services utilization, the Taiwan’s health authority instituted a national health insurance (NHI) program of outpatient dialysis global budget (ODBG) cap for some outpatient dialysis facilities since 2001 and extended to cover all NHI’s outpatient dialysis facilities in 2003. Although the number of patients has increased over the years, the study also found that the frequency of technique failure also increased after the policy implementation, which shows that such an implementation has influenced the behavior of the patient and treatment provider. Further discussions are made to examine whether the high number of patients opting for hemodialysis has helped save costs and whether there is a need to formulate relevant policies in Taiwan for the quality control of treatment.
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