Belgium’s mixed private/public health care system and its impact on the cost of end-stage renal disease

Like most countries, Japan is facing constraints on expansion of health system financial resources. There are almost 250000 Japanese patients with end-stage renal disease and almost all are managed by chronic dialysis. Hospital hemodialysis is the modality used by 96% of these patients. The Japanese health-care system has tended to support resource-intensive treatments because the fee-for-service remuneration system has rewarded their utilization. This has benefited hemodialysis at the expense of peritoneal dialysis. However, this may now be changing. Case management and global budget-related approaches are being more widely introduced, as are incentives to reward more efficient treatment options. The relative costs of dialysis modalities are difficult to appreciate, as center-based services, such as hospital hemodialysis, are dependent upon fixed resources, while home-based options, such as peritoneal dialysis, are dependent upon variable resources. The aim of this review is to reconcile various sources of information relevant to end-stage renal disease funding in Japan. The review will suggest that modifying the approach to modality selection could lead to more efficient allocation of future dialysis-related resources and so reduce the strain on Japan's health-care budget.

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Diabetic Nephropathy: A Comprehensive Review for Health Care Professionals

10.46715/ijde2020.11.1000108 ◽

2020 ◽

pp. 1-10

Author(s):

Sumon Rahman Chowdhur

Keyword(s):

Health Care ◽

Diabetic Nephropathy ◽

Renal Disease ◽

Health Care Professionals ◽

End Stage Renal Disease ◽

Diabetic Patients ◽

Cost Of Health Care ◽

Stage Renal Disease ◽

End Stage ◽

The Cost

The prevalence of Chronic Kidney Disease (CKD) continues to escalate at an alarming rate and diabetes has become the most common single cause of End-Stage Renal Disease (ESRD) in the world. This is because diabetes, particularly type 2, is increasing in prevalence, and the patients are living longer now. Diabetes is the major cause of end-stage renal disease in the developed world, accounting for 40% to 50% of cases. Diabetic nephropathy contributes significantly to the economic burden of diabetes. In UK, the cost of diabetic complications in 2011/2012 was estimated at £14 billion, by 2035/2036 this is expected to rise to £22 billion. Worldwide, healthcare costs for diabetic patients are much higher than non- diabetic patients. Also, among diabetic patients the cost of health care is much higher in those with complications (Micro < Macro<Micro + Macrovascular complications) than in those without complications, therefore identifying and controlling diabetes and its complications is essential in reducing the burden of the disease. In this review we shall explore the pathophysiology, risk factors, staging, screening, management and prognosis of Diabetic Nephropathy in explicit details to make it easily understandable for the Health Care Professionals. Keywords: Diabetic Nephropathy, Diabetes, Health Care Professionals

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Fluid illness

Medicine Anthropology Theory | An open-access journal in the anthropology of health illness and medicine ◽

10.17157/mat.6.1.616 ◽

2019 ◽

Vol 6 (1) ◽

Cited By ~ 1

Author(s):

Jillian Moore ◽

Caitlin Baird ◽

Peter Rohloff

Keyword(s):

Public Health ◽

Health Care ◽

Health Care System ◽

Rural Areas ◽

Family Relations ◽

Public Health Care ◽

Family Based ◽

Stage Renal Disease ◽

End Stage ◽

Care System

In response to the rising rate of end-stage renal disease (ESRD) in Guatemala, the public health system established a national community-based dialysis program to enable people living in rural areas to complete treatment in their homes. Here we explore how this newly available, life-prolonging technology has altered local worlds by transforming ESRD from an acute, life-ending illness into a managed chronic condition with an uncertain trajectory. Through case studies, we describe how living with dialysis influences family relations and caregiving in rural Guatemala. We find that dialysis interacts with an insufficient health care system, one that avoids life-ending complications but does not sufficiently manage life-altering symptoms. In addition, the need to care for people with ESRD for an uncertain amount of time may disrupt and strain family-based caregiving networks. Amid this meager health and social welfare infrastructure, life on dialysis exacerbates the chronic insecurity and structural inequality of life in postwar Guatemala. As both life and illness are prolonged through dialysis, the unceasing demands of the treatment and illness strain the webs of obligation and care that Guatemalan families and communities have developed to adapt to their decentralized and fragmented public health care system.

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Summary & Comment The Cost of Caring for End-Stage Renal Disease Patients: An Analysis Based on Hospital Financial Transaction Records, by Bruns FJ, Seddon P, Saul M, and Zeidel ML. J Am Soc Nephrol 9:884-890, 1998

Seminars in Dialysis ◽

10.1046/j.1525-139x.1999.t01-2-12101.x ◽

1999 ◽

Vol 12 (1) ◽

pp. 56-57

Author(s):

Pradeep Arora ◽

Annamaria T. Kausz ◽

Brian J. G. Pereira

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Financial Transaction ◽

Stage Renal Disease ◽

End Stage ◽

The Cost

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An Economic Evaluation of Disallowing Body Checking in 11- to 12-Year-Old Ice Hockey Leagues

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211021551 ◽

2021 ◽

pp. 194173812110215

Author(s):

Gillian R. Currie ◽

Raymond Lee ◽

Amanda M. Black ◽

Luz Palacios-Derflingher ◽

Brent E. Hagel ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Health Care System ◽

Policy Change ◽

National Policy ◽

Ice Hockey ◽

Public Health Care ◽

Public Health Care System ◽

Body Checking ◽

Care System

Background: After a national policy change in 2013 disallowing body checking in Pee Wee ice hockey games, the rate of injury was reduced by 50% in Alberta. However, the effect on associated health care costs has not been examined previously. Hypothesis: A national policy removing body checking in Pee Wee (ages 11-12 years) ice hockey games will reduce injury rates, as well as costs. Study Design: Cost-effectiveness analysis alongside cohort study. Level of Evidence: Level 3. Methods: A cost-effectiveness analysis was conducted alongside a cohort study comparing rates of game injuries in Pee Wee hockey games in Alberta in a season when body checking was allowed (2011-2012) with a season when it was disallowed after a national policy change (2013-2014). The effectiveness measure was the rate of game injuries per 1000 player-hours. Costs were estimated based on associated health care use from both the publicly funded health care system and privately paid health care cost perspectives. Probabilistic sensitivity analysis was conducted using bootstrapping. Results: Disallowing body checking significantly reduced the rate of game injuries (−2.21; 95% CI [−3.12, −1.31] injuries per 1000 player-hours). We found no statistically significant difference in public health care system (−$83; 95% CI [−$386, $220]) or private health care costs (−$70; 95% CI [−$198, $57]) per 1000 player-hours. The probability that the policy of disallowing body checking was dominant (with both fewer injuries and lower costs) from the perspective of the public health care system and privately paid health care was 78% and 92%, respectively. Conclusion: Given the significant reduction in injuries, combined with lower public health care system and private costs in the large majority of iterations in the probabilistic sensitivity analysis, our findings support the policy change disallowing body checking in ice hockey in 11- and 12-year-old ice hockey leagues.

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