Payment systems for dialysis and their effects: a scoping review

BMC Health Services Research

Research

Rajabali Daroudi¹  Ali Akbari Sari¹  Zahra Emrani¹  Mohammadreza Amiresmaili²  Mohammad Taghi Najafi³ 

[1] Department of Health Policy, Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran;Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran;Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran;Center of Excellence in Nephrology, Tehran, Iran;

关键词: Payment system;    Reimbursement system;    Dialysis;    Efficiency;    Healthcare;   

DOI  :  10.1186/s12913-022-08974-4

 received in 2022-07-06, accepted in 2022-12-15,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundEnd stage renal disease (ESRD) is a major health concern and a large drain on healthcare resources. A wide range of payment methods are used for management of ESRD. The main aim of this study is to identify current payment methods for dialysis and their effects.MethodIn this scoping review Pubmed, Scopus, and Google Scholar were searched from 2000 until 2021 using appropriate search strategies. Retrieved articles were screened according to predefined inclusion criteria. Data about the study characteristics and study results were extracted by a pre-structured data extraction form; and were analyzed by a thematic analysis approach.ResultsFifty-nine articles were included, the majority of them were published after 2011 (66%); all of them were from high and upper middle-income countries, especially USA (64% of papers). Fee for services, global budget, capitation (bundled) payments, and pay for performance (P4P) were the main reimbursement methods for dialysis centers; and FFS, salary, and capitation were the main methods to reimburse the nephrologists. Countries have usually used a combination of methods depending on their situations; and their methods have been further developed over time specially from the retrospective payment systems (RPS) towards the prospective payment systems (PPS) and pay for performance methods. The main effects of the RPS were undertreatment of unpaid and inexpensive services, and over treatment of payable services. The main effects of the PPS were cost saving, shifting the service cost outside the bundle, change in quality of care, risk of provider, and modality choice.ConclusionThis study provides useful insights about the current payment systems for dialysis and the effects of each payment system; that might be helpful for improving the quality and efficiency of healthcare.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 5