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Lesson learnt from implementing a CRRT reimbursement program in a resource-limited setting.

Prit Kusirisin1, Sadudee Peerapornratana2, Jiratorn Sutawong3

  • 1Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center of Excellence in Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Journal of Critical Care
|April 17, 2025
PubMed
Summary
This summary is machine-generated.

Continuous renal replacement therapy (CRRT) is crucial for severe acute kidney injury (AKI). Integrating CRRT into Thailand's Universal Coverage Scheme (UCS) improved patient access and treatment effectiveness, despite initial cost concerns.

Keywords:
Acute kidney injuryContinuous renal replacement therapyReimbursementResource-limited settingThailand

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Area of Science:

  • Nephrology
  • Health Policy
  • Healthcare Economics

Background:

  • Acute kidney injury (AKI) is a critical condition with high mortality and risk of chronic kidney disease.
  • Continuous renal replacement therapy (CRRT) is a vital treatment for severe AKI, especially in critically ill patients.
  • High costs of CRRT pose significant barriers to access, particularly in resource-limited healthcare systems.

Purpose of the Study:

  • To review the policy development process for integrating CRRT into Thailand's Universal Coverage Scheme (UCS).
  • To assess the impact of UCS inclusion on CRRT accessibility and patient outcomes for AKI.
  • To analyze the alignment of reimbursement strategies with clinical needs and financial sustainability.

Main Methods:

  • Policy analysis of CRRT integration proposals and decision-making processes.
  • Review of evidence-based recommendations for reimbursement and budget allocation.
  • Monitoring of patient outcomes and cost-effectiveness following UCS policy implementation.

Main Results:

  • CRRT integration into Thailand's UCS was accepted in 2018 after rigorous policy development.
  • CRRT reimbursement was incorporated into the UCS by 2022, enhancing treatment access for AKI patients.
  • Ongoing evaluation of patient outcomes (mortality, renal recovery, hospital stay) and cost-saving measures.

Conclusions:

  • Successful integration of CRRT into a national health scheme demonstrates the feasibility of overcoming cost barriers.
  • Aligning reimbursement policies with clinical necessities is crucial for equitable and effective AKI treatment.
  • Continuous cost-benefit analysis and policy adjustments are essential for sustainable healthcare delivery.