Prevalence Trend of Renal Replacement Therapy in Thailand: Impact of Health Economics Policy
Kearkiat Praditpornsilpa MD*, Sookruetai Lekhyananda MD*, Nalinee Premasathian MD*, Pornchai Kingwatanakul MD*, Adisorn Lumpaopong MD*, Pongsathorn Gojaseni MD*, Amporn Sakulsaengprapha MD*, Wisit Prasithsirikul MD*, Bunyong Phakdeekitcharoen MD*, Kumthorn Lelamali MD*, Tavichai Teepprasan MD*, Chatsuda Aumanaphong RN*, Benjaporn Leerawat RN*, Jintana Pongpiyadej RN*, Soysaang Srangsomvong RN*, Talerngsak Kanjanabuch MD*, Somchai Eiam-Ong MD*, Kriengsak Vareesaengthip MD*, Dusit Lumlertkul MD*
Affiliation : * The Nephrology Society of Thailand, Bangkok, Thailand
Objective : 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.
Material and Method: The Thailand Renal Replacement Therapy (TRT) database in 2007, 2008, and 2009 were retrieved
and analyzed.
Results : 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.
Conclusion : The coverage of ESRD 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 will finally be the majority of Thai RRT
modalities if the policy can be managed successfully.
Keywords : “PD First” policy, Renal Replacement Therapy, TRT registry data, National health insurance funding
