Policy Recommendations on Extending Access to Renal Replacement Therapy under Universal Coverage in Thailand (ทางเลือกเชิงนโยบายสำหรับขยายการเข้าถึงบริการทดแทนไตภายใต้ระบบหลักประกันสุขภาพถ้วนหน้า)

The aim of this study was to explore policy options for the extension of access to renal replacementtherapy (RRT) under universal coverage in Thailand. Policy options proposed mainly relied ontwo objectives: efficiency in utilizing government health resources and equity in access to healthservices. Human right and ethical principles were also integrated into these policy options.Several research methods including literature reviews, secondary data analysis, in-depth interviewswith stakeholders, and the analysis of policy options based on the WHO manual on ethicaldimensions of health resource allocation were employed. Researchers from IHPP-Thailand, HarvardUniversity, University of Bergen, and the WHO jointly explored this issue during May - June 2005.Results revealed that neither hemodialysis nor peritoneal dialysis was cost-effectiveness dueto its expensive cost per life year saved. However, protecting households against financial catastrophejustified public funding for RRT and to be financially feasible, rationing was unavoidable.Among four alternatives emerging through the extensive literature review and a series of stakeholders’consultation, the study advocated end-stage renal disease (ESRD) prevention and the provisionof RRT to every patient, up to an age cut-off, or to every patient with a fix number of RRT years byproviding more years to the younger patients. These two options were financially feasible andachieve ethical principles of providing equal chance to all patients, while the other two alternativeswhich provide life-time medical services to all or selected some would become relatively less possible.Regardless of which policy options that the government will take, a substantial improvementof many crucial issues including primary and secondary prevention of end-stage renal disease, adequateand sustainable health care financing, an efficient RRT service system, an establishment ofcentral purchasing and bargaining system on peritoneal dialysis (PD) solution and erythropoietininjection, a mandatory report of Thailand registry of renal replacement therapy (TRT registry), incentivesfor PD, and an effective kidney transplantation system is needed.Key words: health policy, efficiency, equity in access to health care, renal replacement therapy, Universal Coverage, health insurance, rationing