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KIDNEY REPLACEMENT THERAPY POLICY OF UNIVERSAL CARE SCHEME IN THAILAND: LESSONS
LEARNED AND THE WAY FORWARD
Home > Research Projects > Strategy 3 : HTA Research > Kidney Replacement
Therapy Policy of Universal Care Scheme in Thailand: Lessons Learned and The Way
Forward
PROJECT CODE
67083002RM008L0
RESEARCH TEAM
RESEARCHERS
Prof. Emeritus Kriang Tungsanga
Prof. Vivekanand Jha
CO - RESEARCHER
Dr. Jadej Tammatacharee
Dr. Suwit Wibulpolprasert
Dr. Somsak Chunharas
Vuddhidej Ophascharoensuk, M.D
Dr. Piyathida Chuengsaman
Dr. Talernsak Kanjanabuch
Dr. Kearkiat Praditpornsilpa
Dr. Valerie Luyckx
Dr. Gloria Ashuntantang
Dr. Fatiu Arogundade
Dr. Sydney Tang
Dr. Laura Sola
Yot Teerawattananon, PhD.
Wanrudee Isaranuwatchai, PhD.
Saudamini Vishwanath Dabak
Kinanti Khansa Chavarina
Jirathorn Sutawong
Chulathip Boonma
Tanainan Chuanchaiyakul
Jeerath Phannajit, M.D
Natcha Yongphiphatwong
Dr. Wirun Limsawart
Jutamas Piyawong
Suphichcha Thitjuea
PROJECT DETAILS
Strategies
* Strategy 3 : HTA Research
Category
* Health Policies
Support
* Health Systems Research Institute(HSRI)
Tags
* Dialysis policy
* Policy
Country
Project duration
Start: - June 2023
End: - December 2024
Contact
Kinanti.c@hitap,net
PROJECT STATUS
Conducting Research - 65%
Viewer: 1472
Publish date3 August 2023 02:29
PROJECT SUMMARY
Kidney failure (KF)[1] is a life-threatening disease that requires either kidney
transplantation or dialysis for survival (1, 2). As of 2019, it was estimated
that globally, 1.4 million deaths occurred on account of chronic kidney disease
(CKD) (3). The cost of treatment for KF is also high, leading to catastrophic
household expenditure to households. Given the nature of the disease and the
lack of affordability for households (4), it has been argued that countries
might not achieve Universal Health Coverage (UHC), one of the Sustainable
Development Goals (SDGs), without support for treating KF.
Thailand adopted UHC in 2002 when it introduced the Universal Coverage Scheme
(UCS), covering more than 70% of the Thai population that was not enrolled in
the Civil Servant Medical Benefit Scheme (CSMBS), for civil servants, and the
Social Security Scheme (SSS), for non-government private sector employees (5).
At this time, Thailand was one of a few lower-middle-income countries that
introduced UHC, even as it was recovering from the 1997 financial crisis (6).
However, treatment for KF was not included in the benefits package for UCS as
there were concerns about the financial sustainability of this program should it
be included. There were equity concerns as since 1998, Thailand had been fully
reimbursing hemodialysis (HD) and peritoneal dialysis (PD) for ESRD patients
covered by the CSMBS and SSS (7). This meant that only beneficiaries of the UCS,
who were not covered by either the CSMBS or SSS, had to shoulder the cost of
their life-saving treatment on their own (8, 9). In addition, most UCS
beneficiaries came from lower-income groups with a relatively high prevalence of
KF patients (10).
In response to growing pressure to include kidney replacement therapy (KRT) by
multiple stakeholders, including professional organizations, non-profit
organizations, researchers, patient groups, and dialysis providers, the
government commissioned research to identify potential policy options (5). This
included conducting a cost-effectiveness analysis of KRT and understanding the
out-of-pocket costs for households, among others (11, 12). This advocacy process
was the first in Thailand that used considerable evidence for the Universal Care
Benefit Package (UCBP), the benefits package in the UCS scheme. In 2008, these
efforts came to fruition by including the 'PD first' policy in the UCBP (10,
13). It allows patients eligible for PD to choose between PD or HD, with
consequences of fully self-fund for choosing the latter (7). As for patients
that are unsuitable for PD treatment, they can access HD without having to pay
out-of-pocket expenses (7).
Thailand adopted multiple strategies that led to a successful implementation the
‘PD first’ policy, including incentives for patients and providers, bulk
procurement of PD solutions, collaboration with training centers, health
professionals associations, and non-profit organizations to improve the capacity
of healthcare workers, increase the number of PD centers, and encourage PD
centers to create local kidney patient clubs (5). The PD-first policy has had
massive success with rapidly improved access to dialysis (14), better patient
outcomes (14, 15) and is widely recognized (7, 13). Other low- and middle-income
countries (LMICs), such as Indonesia and the Philippines, have also studied the
cost-effectiveness of providing KRT, and countries such as India and Kenya have
sought to learn from Thailand’s experience of implementing its dialysis policy
(16, 17).
The policy remained in implementation for about 15 years until 2022, when a
‘free choice’ dialysis policy was introduced (18). The ‘free choice dialysis'
policy allows PD and HD to be reimbursed for eligible patients, accommodating
individual’s preference of dialysis (18). This policy grants patients greater
flexibility to choose their dialysis treatments; however, it might pose an
additional THB 28,000 or USD 811[2] per patient per year to the patients who
select HD over PD due to more frequent hospital visits (5). The policy has the
potential to impose a higher burden on the system, considering the higher cost
of HD compared to PD, although, the extent of the impact should be assessed
further.
Given Thailand’s experience in developing and implementing dialysis policies in
a budgetary constraint setting, this study hopes to understand the evolution of
the processes and highlight learnings that may be relevant for LMICs. This study
will invite Thai UCS implementing agencies and international groups of scholars
to draw lessons on why and how Thailand decided to adopt the PD first policy,
how it was sustained for fifteen years, and the potential impacts of the new
policy. This study would be relevant to Thai and international contexts,
especially LMICs struggling to fund dialysis, an expensive, recurring,
life-saving treatment (19).
We have a learning committee comprised of Thai and international experts who are
involved in this study:
Co-chairs:
1. Kriang Tungsanga
2. Vivekanand Jha
Committee members:
1. Vuddhidej Ophascharoensuk
2. Jadej Tammatacharee
3. Suwit Wibulpolprasert
4. Somsak Chunharas
5. Piyathida Chuengsaman
6. Talernsak Kanjanabuch
7. Kearkiat Praditpornsilpa
8. Valerie Luyckx
9. Gloria Ashuntantang
10. Fatiu Arogundade
11. Sydney Tang
12. Laura Sola
Secretariat:
1. Yot Teerawattananon
2. Saudamini Dabak
3. Kinanti Khansa Chavarina
4. Jiratorn Sutawong
5. Jeerath Phannajit
6. Chulathip Boonma
Research team:
1. Yot Teerawattananon
2. Saudamini Dabak
3. Kinanti Khansa Chavarina
4. Jiratorn Sutawong
5. Jeerath Phannajit
6. Chulathip Boonma
7. Tanainan Chuanchaiyakul
8. Wirun Limsawart
9. Jutamas Piyawong
10. Supichcha Thitjuea
References
1. Levey AS, Eckardt KU, Dorman NM, Christiansen SL, Cheung M, Jadoul M, et
al. Nomenclature for Kidney Function and Disease: Executive Summary and
Glossary from a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus
Conference. Kidney Dis (Basel). 2020;6(5):309-17.
2. Wong CKH, Chen J, Fung SKS, Mok M, Cheng YL, Kong I, et al. Lifetime
cost-effectiveness analysis of first-line dialysis modalities for patients
with end-stage renal disease under peritoneal dialysis first policy. BMC
Nephrol. 2020;21(1):42.
3. Global Burden of Disease (GBD) 2019 [Internet]. 2019 [cited 19 June 2023].
Available from: http://www.healthdata.org/gbd/2019.
4. Dodd R, Palagyi A, Guild L, Jha V, Jan S. The impact of out-of-pocket costs
on treatment commencement and adherence in chronic kidney disease: a
systematic review. Health Policy Plan. 2018;33(9):1047-54.
5. Chuengsaman P, Kasemsup V. PD First Policy: Thailand's Response to the
Challenge of Meeting the Needs of Patients With End-Stage Renal Disease.
Semin Nephrol. 2017;37(3):287-95.
6. Sumriddetchkajorn K, Shimazaki K, Ono T, Kusaba T, Sato K, Kobayashi N.
Universal health coverage and primary care, Thailand. Bull World Health
Organ. 2019;97(6):415-22.
7. Kanjanabuch T, Takkavatakarn K. Global Dialysis Perspective: Thailand.
Kidney360. 2020;1(7):671-5.
8. Teerawattananon Y, Tangcharoensathien V. Designing a reproductive health
services package in the universal health insurance scheme in Thailand:
match and mismatch of need, demand and supply. Health Policy Plan. 2004;19
Suppl 1:i31-i9.
9. Treerutkuarkul A. Thailand: health care for all, at a price. Bull World
Health Organ. 2010;88(2):84-5.
10. Tantivess S, Werayingyong P, Chuengsaman P, Teerawattananon Y. Universal
coverage of renal dialysis in Thailand: promise, progress, and prospects.
BMJ. 2013;346:f462.
11. Prakongsai P, Palmer N, Uay-Trakul P, Tangcharoensathien V, Mills A. The
Implications of Benefit Package Design: The Impact on Poor Thai Households
of Excluding Renal Replacement Therapy. Journal of International
Development, Forthcoming. 2009.
12. Teerawattananon Y, Mugford M, Tangcharoensathien V. Economic evaluation of
palliative management versus peritoneal dialysis and hemodialysis for
end-stage renal disease: evidence for coverage decisions in Thailand. Value
Health. 2007;10(1):61-72.
13. Liu FX, Gao X, Inglese G, Chuengsaman P, Pecoits-Filho R, Yu A. A Global
Overview of the Impact of Peritoneal Dialysis First or Favored Policies: An
Opinion. Perit Dial Int. 2015;35(4):406-20.
14. Kanjanabuch T, Puapatanakul P, Halue G, Lorvinitnun P, Tangjittrong K,
Pongpirul K, et al. Implementation of PDOPPS in a middle-income country:
Early lessons from Thailand. Perit Dial Int. 2022;42(1):83-91.
15. Dhanakijcharoen P, Sirivongs D, Aruyapitipan S, Chuengsaman P, A L. The "PD
First" policy in Thailand: three-years experiences (2008-2011). J Med Assoc
Thai. 2011;94:S153-61.
16. Afiatin, Khoe LC, Kristin E, Masytoh LS, Herlinawaty E, Werayingyong P, et
al. Economic evaluation of policy options for dialysis in end-stage renal
disease patients under the universal health coverage in Indonesia. PLoS
One. 2017;12(5):e0177436.
17. Bayani DBS, Almirol BJQ, Uy GDC, Taneo MJS, Danguilan RS, Arakama MI, et
al. Filtering for the best policy: An economic evaluation of policy options
for kidney replacement coverage in the Philippines. Nephrology (Carlton).
2021;26(2):170-7.
18. National Health Security Office. ตั้งแต่ 1 ก.พ.นี้
ผู้ป่วยไตวายเรื้อรังสิทธิบัตรทองตัดสินใจร่วมกับแพทย์เพื่อเลือกวิธีฟอกไตที่เหมาะสมได้.
2022 [Available from: https://www.nhso.go.th/news/3471.
19. Mushi L, Marschall P, Flessa S. The cost of dialysis in low and
middle-income countries: a systematic review. BMC Health Serv Res.
2015;15:506.
[1] The term ‘kidney failure’ is used to substitute ‘end-stage kidney disease’
or ‘end-stage renal disease’ as recommended by the Kidney Disease: Improving
Global Outcomes (KDIGO) Consensus Conference (1)
[2] 1 USD is equivalent to THB 35
DOCUMENTS
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