Payment systems for dialysis and their effects: a scoping review

Area of Science:

• Health Economics
• Healthcare Management
• Renal Medicine

Background:

• End-stage renal disease (ESRD) presents a significant healthcare challenge and financial burden.
• Diverse payment methodologies are employed for ESRD management, particularly for dialysis services.
• Identifying and evaluating current dialysis payment systems and their impacts is crucial for optimizing care delivery.

Purpose of the Study:

• To conduct a scoping review of current payment methods for dialysis care.
• To analyze the effects of various reimbursement strategies on healthcare services and patient outcomes.

Main Methods:

• A comprehensive scoping review was performed using PubMed, Scopus, and Google Scholar (2000-2021).
• Articles were screened based on predefined inclusion criteria, with data extracted using a standardized form.
• Thematic analysis was employed to analyze extracted data on study characteristics and findings.

Main Results:

• Fifty-nine articles were included, predominantly from high-income countries (USA: 64%), with most published after 2011 (66%).
• Key reimbursement methods for dialysis centers included Fee-for-Service (FFS), global budgets, capitation, and Pay-for-Performance (P4P). Nephrologists were primarily reimbursed via FFS, salary, or capitation.
• Payment systems have evolved from Retrospective Payment Systems (RPS) towards Prospective Payment Systems (PPS) and P4P. RPS led to undertreatment of some services, while PPS resulted in cost savings but potential shifts in service costs and impacts on care quality and modality choice.

Conclusions:

• The study offers valuable insights into contemporary dialysis payment systems and their respective consequences.
• Understanding these payment mechanisms can inform strategies for enhancing the quality and efficiency of renal healthcare services.