Different Levels Of Henan Province Hospital ESRD Dialysis Medicare Optimization

Objective To understand and compare the direct economic burden of peritoneal dialysis and hemodialysis on nephrosis patients at terminal and to analyze the differences between the costs of two treatments in different medical insurance policy and to analyze the difference of reimbursement and payment method between different levels of medical insurance in Henan Province. Recommending the treatment with less direct economic burden so as to provide empirical evidence for health policy of health authorities and health insurers, in order to meet the needs of dialysis treatment in patients with end stage renal disease to reduce the burden of medical expenses, and to save society health resource.Methods This study began in 2015. Patients undergoing hemodialysis for more than 3 months in 10 pilot hospitals of Henan Province were selected. The comparison analysis was conducted by hospital level(level 3 hospitals, level 2 hospitals), among, Zhengzhou, Luoyang, and Xinxiang, respectively. The economic burden of disease and medical insurance reimbursement in different levels of hospital and different regions were compared. Research data were collected from medical records and retrospective investigation, including: gender, age, marital status, education level, the institution, the type of health insurance, direct medical costs, pharmaceutical costs of kidney disease, pharmaceutical costs of complications, laboratory fees, self-paid fees, borrowing costs, medicare reimbursement, social assistance costs, dialysis effect, and patient satisfaction. Epidata 3.1 was used to establish a database and data were double entered, statistical analysis was conducted by using SPSS 21.0.Results Four hundred patients from Henan dialysis pilot hospitals were selected, including 301 patients undergoing hemodialysis and 99 patients undergoing peritoneal dialysis. The insured situation of kidney dialysis patients(medical insurance for urban workers, medical insurance for urban residents, the new rural cooperative medical care, free medical service, commercial health insurance and other insurance business) were selected, the c2 test showed that the difference was not statisticallysignificant(P>0.05), The number of hemodialysis patients were more than peritoneal dialysis, among the hemodialysis patients, the number of medical insurance for urban workers is the largest(n=128), the number of peritoneal dialysis patients with the new rural cooperative medical was the least(n=64). The number of hemodialysis patients with medical insurance for urban workers in Zhengzhou was the largest(n=72); the number of peritoneal dialysis patients with the new rural cooperative medical in Xinxiang is the least(n=37). The c2 test showed that there is no statistically significant difference(P>0.05) in gender, age, marital status, education level among kidney dialysis patient. The direct medical expenses of patients with renal dialysis in Henan province were different from that of the patient self paid fees, Non parametric test showed that the difference was statistically significant(P<0.05). The economic burden of disease on kidney dialysis patients was heavy. Non parametric test showed that there is statistically significant difference(P<0.05) among the financial burden of medical insurance for urban workers, medical insurance for urban residents, and the new rural cooperative medical care. The direct medical costs of hemodialysis with medical insurance for urban workers, medical insurance for urban residents, the new rural cooperative medical care, and other health insurance was higher than that of peritoneal dialysis in Henan province. Non parametric test showed that there is statistically significant difference(P<0.05) among the self paid fees of medical insurance for urban workers, medical insurance for urban residents, and the new rural cooperative medical care in Henan province. There is statistically significant difference(P<0.05) among the drug cost of nephropathy of medical insurance for urban workers, medical insurance for urban residents, and the new rural cooperative medical care in Henan province. Due to complications caused by long-term dialysis therapy had also become a major problem in kidney dialysis patients which could not be ignored; Henan kidney dialysis medical insurance for urban workers, medical insurance for urban residents, complications in patients with drug costs because of new rural cooperative medical dialysis generated, by the non-parametric test, the difference was statistically significant(P<0.05). Renal dialysis patients with Henan urban medical insurance, new rural cooperative medical examination costs, by the non-parametric test, the difference was statistically significant(P<0.05). Dialysis treatment was mainly evaluated from the ability to work, social activities, daily life, health, mental state and other aspects of renal dialysis patients inlabor ability, social skills, daily living health and mental state, etc., and by the c2 test the difference was not statistically significant(P>0.05). After hemodialysis, patients were not working properly and the proportion hardly participate in social activities was higher than peritoneal dialysis; peritoneal dialysis patient in health felt better than the proportion of hemodialysis patients. Of 400 kidney dialysis patient satisfaction surveys included whether the treatment convenient medical services which the hospital provided for was satisfactory, the process of Medicare reimbursement was simple or not and so on, in the treatment of convenience aspect, the c2 test, hemodialysis and peritoneal dialysis patients Differences statistically significant(P<0.05). In the service of the hospital are satisfied and whether simple aspect of Medicare reimbursement, the c2 test, hemodialysis patients and peritoneal dialysis patients was with no significant difference(P>0.05).Conclusions The economic burden on hemodialysis patients is higher than that on peritoneal dialysis patient, Even though there is no statistically significant difference between the effect of the two dialysis treatments, and peritoneal dialysis is simple, inexpensive, and patient satisfaction of peritoneal dialysis is higher than that of hemodialysis. The advantage of peritoneal dialysis is difficult to reflect because of special Chinese the medical insurance systems: the reimbursement rate of hemodialysis is higher. Choosing an economically fair dialysis mode and designing proper payment policies and standards according to the economic characteristics of different regions, are important for the patients to reduce the financial burden.