Organisatie en financiering van chronische dialyse in België [printed text] / Irina Cleemput  , Author ; Claire Beguin, Author ; Yolande De La Kethulle, Author ; Sophie Gerkens , Author ; Michel Jadoul, Author ; Gert Verpooten, Author ; Chris De Laet , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2010 . - XI, 224 p. : ill. ; A4. - ( KCE Reports A. Health Technology Assessment (HTA); 124 A) . ISSN : D/2010/10.273/11 : 0 € Studie nr : 2007-12 Languages : Dutch ( dut) English ( eng)
| Descriptors: |
Indexation
2007-12 ; Accreditation ; Costs and Cost Analysis ; Patient Preference ; R124 ; Reimbursement, Incentive
Classification
WJ 378 - Artificial kidney. Renal dialysis. Peritoneal dialysis
|
| Abstract: |
Deze studie concentreert zich voornamelijk op de criteria voor de keuze tussen de verschillende dialysemodaliteiten: hemodialyse in het ziekenhuis, hemodialyse in een satellietcentrum of thuis, peritoneale dialyse. Daarnaast wordt ook gekeken naar de organisatie van chronische dialyse in België, de kosten van de verschillende alternatieve dialysemodaliteiten en de financiering van deze activiteiten. Hebben de inspanningen om de alternatieven naast de klassieke hemodialyse in het ziekenhuis te stimuleren hun doel bereikt of niet? Tenslotte stellen we ons ook de vraag in hoeverre de patiënt hierbij mag meepraten. |
| Contents note: |
Table of contents -- ABBREVIATIONS 4 -- 1 INTRODUCTION 7 -- 1 1 BACKGROUND 7 -- 1 2 TECHNOLOGY OVERVIEW 7 -- 1 2 1 Dialysis 7 -- 1 2 2 Haemodialysis 7 -- 1 2 3 Peritoneal dialysis 8 -- 1 3 THE ISSUE 9 -- 1 4 OBJECTIVES 10 -- 2 LITERATURE REVIEW OF CLINICAL AND ECONOMIC ASPECTS OF -- CHRONIC DIALYSIS 11 -- 2 1 INTRODUCTION 11 -- 2 2 METHODS 13 -- 2 2 1 Literature search criteria 13 -- 2 2 2 Main MeSH terms and definitions 13 -- 2 2 3 Selected literature 13 -- 2 2 4 Terminology 14 -- 2 3 MORTALITY AND MORBIDITY 14 -- 2 3 1 Hospital HD versus satellite HD versus home HD 14 -- 2 3 2 Continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis -- (APD/CCPD) 15 -- 2 3 3 PD versus HD 15 -- 2 4 QUALITY OF LIFE 17 -- 2 4 1 Background 17 -- 2 4 2 Results 17 -- 2 5 COSTS AND COST-EFFECTIVENESS OF DIALYSIS MODALITIES 18 -- 2 5 1 Costs of dialysis modalities 18 -- 2 5 2 Cost-effectiveness of dialysis modalities 20 -- 2 6 CHOICE OF A SPECIFIC DIALYSIS MODALITY IN INDIVIDUAL PATIENTS 21 -- 2 6 1 Medical indications and contra-indications for specific dialysis modalities 21 -- 2 6 2 Patient choices 22 -- 2 7 PREDIALYSIS PATIENT EDUCATION 23 -- 2 8 CONCLUSION 24 -- 3 BELGIAN SITUATION 25 -- 3 1 EPIDEMIOLOGY 25 -- 3 1 1 The patient population 25 -- 3 1 2 Renal Transplants 28 -- 3 1 3 Use of different dialysis modalities for ESRD in Belgium 31 -- 3 2 CLINICAL CHARACTERISTICS OF DIALYSIS PATIENTS 35 -- 3 3 PLANNING, ORGANISATION AND REGULATION 35 -- 3 3 1 Legal aspects 35 -- 3 3 2 Dialysis facilities in Belgium 37 -- 3 3 3 Real-world relevance of norms and rules for hospital and satellite HD units 37 -- 3 4 FINANCING OF CHRONIC RENAL FAILURE MANAGEMENT 39 -- 3 4 1 General Principles 39 -- 3 4 2 Historical evolution of dialysis financing mechanisms 39 -- 3 4 3 Current financing of hospital haemodialysis 44 -- 3 4 4 Current financing of satellite HD, home HD and PD 46 -- 3 4 5 Summary of financing mechanisms for the different types of dialysis 47 -- 3 4 6 National expenditures for dialysis between 2002 and 2008 50 -- 3 4 7 Differences in use of alternative dialysis modalities between centres and between -- regions 52 -- 3 4 8 Income from dialysis for hospitals 54 -- 4 PATIENT CHARACTERISTICS, PUBLIC REIMBURSEMENT AND OUT-OFPOCKET -- EXPENSES 55 -- 4 1 INTRODUCTION AND OBJECTIVES 55 -- 4 2 METHOD 55 -- 4 2 1 Financing of dialysis 55 -- 4 2 2 Inclusion criteria 55 -- 4 2 3 Working definitions 55 -- 4 2 4 Patient profiles 56 -- 4 2 5 Data analysis and presentation of results 56 -- 4 3 PATIENT CHARACTERISTICS 57 -- 4 3 1 Number of individuals receiving chronic dialysis treatment 57 -- 4 3 2 Number of patients by year of treatment and dialysis modality 57 -- 4 3 3 Age and gender 58 -- 4 3 4 Starting, continuing and stopping dialysis 61 -- 4 3 5 Mortality 62 -- 4 4 PUBLIC REIMBURSEMENTS FOR CHRONIC DIALYSIS PATIENTS: CROSS-SECTIONAL -- ANALYSIS PER YEAR 64 -- 4 4 1 NIHDI reimbursements 65 -- 4 4 2 Ambulatory dialysis 66 -- 4 4 3 Hospital stays and one-day clinic 68 -- 4 4 4 Ambulatory consultations 71 -- 4 4 5 Ambulatory medication 73 -- 4 4 6 Venofer® (intravenous iron) 74 -- 4 5 OUT-OF-POCKET EXPENSES FOR CHRONIC DIALYSIS PATIENTS: CROSS-SECTIONAL -- ANALYSIS PER YEAR 75 -- 4 5 1 Total out-of-pocket expenses for reimbursed health care items 75 -- 4 5 2 Ambulatory dialysis 77 -- 4 5 3 Hospital stays and one-day clinic 78 -- 4 5 4 Ambulatory consultations 80 -- 4 5 5 Ambulatory medication 81 -- 4 6 PUBLIC REIMBURSEMENTS FOR CHRONIC DIALYSIS PATIENTS: LONGITUDINAL -- ANALYSIS FOR INCIDENT PATIENTS 82 -- 4 6 1 Overall reimbursements 82 -- 4 6 2 Average reimbursement per patient 83 -- 4 7 OVERVIEW AND CONCLUSIONS 84 -- 4 7 1 Patients 84 -- 4 7 2 Expenses for the public payer (NIHDI) 85 -- 4 7 3 Out-of-pocket expenses for the patient 86 -- 4 7 4 Expenses before and after starting dialysis 87 -- 5 THE COSTS AND REVENUES OF DIFFERENT DIALYSIS MODALITIES IN -- BELGIUM FROM THE HOSPITAL PERSPECTIVE 88 -- 5 1 INTRODUCTION 88 -- 5 2 COSTS OF HOSPITAL HD, SATELLITE HD AND PD 88 -- 5 2 1 Methods 88 -- 5 2 2 Results 99 -- 5 3 COSTS AND REVENUES OF A DIALYSIS PROGRAMME FROM A HOSPITAL’S -- PERSPECTIVE 103 -- 5 3 1 Methods 103 -- 5 3 2 Results 106 -- 5 4 DISCUSSION 112 -- 5 4 1 Cost analysis 112 -- 5 4 2 Simulation of revenues and costs 113 -- 6 INTERNATIONAL COMPARISON 115 -- 6 1 INTRODUCTION 115 -- 6 2 ORGANISATION OF CARE FOR ESRD PATIENTS 115 -- 6 2 1 Incidence and prevalence 115 -- 6 2 2 Number of nephrologists 116 -- 6 2 3 Geographical access to dialysis facilities 117 -- 6 2 4 Distribution of patients between treatment modalities 117 -- 6 2 5 Incentives and criteria influencing the choice of the treatment 119 -- 6 3 ESRD FUNDING 120 -- 6 3 1 Introduction 120 -- 6 3 2 National budget for ESRD patients 120 -- 6 3 3 Financing of dialysis physicians 121 -- 6 3 4 Financing of dialysis units 122 -- 6 3 5 Patients’ co-payments 123 -- 6 3 6 Cost containment measures 124 -- 7 PATIENT PERSPECTIVE IN CHRONIC DIALYSIS 126 -- 7 1 INTRODUCTION 126 -- 7 2 OBJECTIVES 126 -- 7 3 METHODS 126 -- 7 4 RESULTS 128 -- 7 4 1 Methodological problems 128 -- 7 4 2 Reported issues by patients 128 -- 7 4 3 Information 128 -- 7 4 4 Choice between dialysis modalities 129 -- 7 4 5 Advantages and disadvantages of different dialysis modalities 130 -- 7 4 6 Support in case of home dialysis treatments 131 -- 7 4 7 Financial issues 131 -- 7 5 PSYCHOSOCIAL CONSIDERATIONS 132 -- 7 6 CONCLUSION 132 -- 7 6 1 Our survey 132 -- 7 6 2 Previous studies 133 -- 8 DISCUSSION AND CONCLUSIONS 136 -- 8 1 EPIDEMIOLOGY OF RENAL REPLACEMENT THERAPY IN BELGIUM 136 -- 8 2 RELATIVE EFFECTIVENESS OF DIALYSIS MODALITIES 137 -- 8 3 COSTS OF DIALYSIS MODALITIES FROM A HOSPITAL PERSPECTIVE 137 -- 8 4 COST-EFFECTIVENESS OF DIALYSIS MODALITIES 138 -- 8 5 COSTS AND REIMBURSEMENT 138 -- 8 6 LICENSING OF DIALYSIS CENTRES 140 -- 8 7 NIHDI EXPENDITURES 141 -- 8 8 INTERNATIONAL COMPARISON 141 -- 8 9 PATIENT-RELATED ISSUES 142 -- 8 10 LIMITATIONS OF THE REPORT 142 -- 8 11 FINAL CONCLUSION 142 -- 9 APPENDICES 143 -- APPENDIX TO CHAPTER 2 143 -- APPENDIX TO CHAPTER 4 187 -- APPENDIX TO CHAPTER 5 203 -- APPENDIX TO CHAPTER 7 215 -- 10 REFERENCES 221 |
| Link for e-copy: |
http://doi.org/10.57598/R124A |
| Format of e-copy: |
PDF (2,56 Mb) |
| Record link: |
https://kce.docressources.info/index.php?lvl=notice_display&id=1860 |
|  |
Add the result to your basket Make a suggestion Refine your search Apply to external sourcesComparative study of hospital accreditation programs in Europe / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2008)
