Chapter 3: Economics of Dialysis. Lim TO Goh A

Transcription

1 Chapter 3: Economics of Dialysis Lim TO Goh A 16th Report of the Malaysian Dialysis and Transplant Registry 28 1

2 Table 3.1: Trends in Malaysian GDP, population health and dialysis provision, GDP per capita (in 25RM) Life expectancy at birth (years) Under 5 mortality (per 1,) Urban population (% of total) Treated RRT incidence Treated RRT prevalence Data sources: International Monetary Fund World Economic Outlook Database, World Bank HNP Stats, Malaysian National Renal Registry. 2

3 Table 3.2: Prevalence of renal replacement therapy (RRT), dialysis and renal transplant among various regions in the world [2] and by Countries per capita Gross National Income (GNI) according to World Bank classification [3] AARegion/ Country North America Europe Japan Asia (excluding Japan) Latin America Africa Middle East Malaysia (GNI USD57) High income countries (GNI>USD 9386) Upper middle income countries (GNI USD ) Lower middle income countries (GNI USD ) Low income countries (GNI< USD 766) RRT Prevalence rate in per million population Dialysis Transplant Data Sources: Grassmann A, Gioberge S, Moeller S et al. ESRD patients in 24: global overview of patient numbers, treatment modalities and associated trends. Nephrol Dial Transplant 25; 2: White SL, Chadban SJ, Jan S, Chapman JR, Cass A. How can we achieve global equity in provision of renal replacement therapy? Bull World Health Organ. 28;86:

4 Figure 3.2(a) Prevalence of renal replacement therapy (RRT) among various regions in the world 25 and by countries per capita GNI according to World Bank classification 2, per million population 1,5 1, 5 Low income countries Africa Asia (excl Jpn) Lower middle income countries Middle East Upper middle income countries Latin America Malaysia Europe High income countries Nth America Japan 4

5 Figure 3.2(b): International comparison of income & RRT treatment prevalence, 25 Data: USRDS Annual Data Report 27, World Bank World Development Indicators 5

6 Figure 3.1(a): Dialysis incidence and GDP per capita, per million population GDP per capita, 25 RM RRT incidence (pmp) year... GDP/capita, 25RM Data sources: International Monetary Fund World Economic Outlook Database, Malaysian National Renal Registry. 6

7 Figure 3.1(b): Dialysis prevalence and GDP per capita, per million population GDP per capita, 25 RM year... RRT prevalence (pmp) GDP/capita, 25RM Data: International Monetary Fund World Economic Outlook Database, Malaysian National Renal Registry 7

8 Table 3.3: Trends in dialysis funding and provider mix Dialysis incidence Dialysis prevalence Sectoral share of provision (%) % Public % NGO % Private Funding for dialysis (25 RM million) Public Charity Private Total Funding for dialysis (%) % Public % Charity % Private Note on total cost: expenditure estimate based on private sector inflation adjusted HD prices from to 25 and govt HD/CAPD inflation adjusted costs in 1996 & 21. 8

9 Figure 3.3(a): Dialysis funding by sector, -25 (RM million) RM million Govt Private Charity 9

10 Figure 3.3(b): Dialysis funding by sector, -25 (%) % funding Public Private Charity 1

11 Table 3.3: Trends in dialysis funding and provider mix Dialysis incidence Dialysis prevalence Sectoral share of provision (%) % Public % NGO % Private Funding for dialysis (25 RM million) Public Charity Private Total Funding for dialysis (%) % Public % Charity % Private Note on total cost: expenditure estimate based on private sector inflation adjusted HD prices from to 25 and govt HD/CAPD inflation adjusted costs in 1996 &

12 Table 3.4: Trends in resource generation for dialysis treatment Resource generation for Dialysis Trained nephrologists, No Trained dialysis nurses and medical assistants^, number per year (%) Public (89) Private 16 (11) Total 32 (1) 15 (1) 96 (1) 14 (1) HD facilities by sector, No. (%) Public 22 (9) 3 (42) 56 (35) 153 (39) NGO () 12 (17) 51 (32) 99 (25) Private 15 (41) 3 (42) 54 (34) 144 (36) Total 37 (1) 72 (1) 161 (1) 396 (1) HD machine by sector, No. (%) Public 664 (3) 1142 (29) NGO 83 (37) 1427 (37) Private 75 (33) 1317 (34) Total 2244 (1) 3886 (1) ^Trained by Ministry of Health and National Kidney Foundation. 12

13 Figure3.4(a): Dialysis human resources, -25 Figure 3.4(b): Haemodialysis centres by sector, Nephrologists Nurses trained HD centres, Govt HD centres, NGO HD centres, private Figure 3.4(c): HD machines by sector, -25 1, 2, 3, 4, 25 HD machines, Govt HD machines, NGO HD machines, private 13

14 Table 3.5: Trends in dialysis market prices Dialysis prevalence Price per HD (current RM) Price per HD (25RM) Average Household monthly income (25RM) HD cost to monthly HH income (%) Note: a1999, b24, c1992-5, d1996-9, e-2, f23-5 Data: Private sector HD prices were from a 27 survey of 12 private HD centres in Peninsular Malaysia, Malaysia Plan reports 44 17c 286c d 225d e 191e 312a f 168f 3356b 65 14

15 Figure 3.5(a): Trends in dialysis cost-efficiency (HD price in 25 RM) per million population Year... Dialysis prevalence Price per HD RM Figure 3.5(b): Trends in dialysis cost-efficiency (HD price as % of household income) per million population Year... Dialysis prevalence HD cost to income % household income Figure 3.5(c): Trends in dialysis costs: Actual and assuming no efficiency gained patients Year... patients High Cost Actual Cost RM million 15

16 Table 3.6: International comparison of dialysis cost efficiency, 25 M sia US UK Aust Dialysis incidence Dialysis prevalence Price per HD (25RM/US$/ /A$) Mean Household monthly income (25RM/US$/ /A$) HD cost* to monthly HH income (%) 65% 37% 8% 37% Note: *assuming 13 HD procedures per month 16

17 Table 3.8 Geographic distribution of dialysis Treatment in Malaysia, Dialysis prevalence Johor Kedah & Perlis Kelantan Melaka Negeri Sembilan Pahang Perak Penang Sabah Sarawak Selangor & WP Trengganu

18 Figure 3.8: Distribution of Dialysis treatment in Malaysia by state, -25 Sabah Kelantan Pahang Trengganu Sarawak Ked & Per Malaysia Ng Semb Perak Sel & WP Johor Melaka Penang Dialysis prevalence, per million population Prevalence rate Prevalence rate 1995 Prevalence rate Prevalence rate 25 18

19 Table 3.9: Trends in dialysis geographic equity as measured by concentration indices 1995 Dialysis incidence Dialysis prevalence Overall Concentration Index (CI) of dialysis provision CI of Public provision CI of NGO provision CI of Private provision Household Income inequality (Gini coefficient ) * # Figure 3.9(a): Trends in dialysis geographic equity in Malaysia, -25 Figure 3.9(b): Concentration curves of geographic distribution of dialysis treatment by provider sector, 25 Concentration Index year Overall NGO Public Private Cumulative % treatment Cumulative % population (ranked by income) Treatment NGO Equality Government Private 19

20 Table 3.7: Dialysis financing equity, 25 Sector Concentration Index Kakwani Public Private Overall Figure 3.7: Dialysis financing equity as measured by Kakwani index, 25 Cumulative % financing/income Cumulative % population (ranked by income) Cumulative Financing Cumulative Public financing Equality Lorenz Curve Cumulative Private financing 2