Policy Forum PerspectiveDialysis Care and Dialysis Funding in Asia
Section snippets
Mainland China
Mainland China has a chronic kidney disease (CKD) prevalence of 10.8%,3 with substantial variability between urban and rural areas. In the southern province of Guangdong, the prevalence of CKD in the urban population is estimated at 10.1%, while prevalence in the rural population is as high as 13.6%.4, 5 The estimated prevalence of kidney failure in mainland China is about 200 to 250 cases per million population (pmp). The annual cost of peritoneal dialysis (PD) is approximately US $1,300,
Singapore
In Singapore, health care financing is disbursed through heavy government subsidies and a 3M framework14: Medisave, Medishield Life, and Medifund (Fig 1). These subsidies are available at tiered amounts based on income. Medishield Life is a basic health insurance plan available to all that provides coverage for dialysis but is capped at US $750 per month or 90% of the remaining cost after government subsidies, whichever is lower. Medisave is a compulsory personal savings plan for those who are
India
India has a federal structure comprising 29 states and 7 union territories; the process of kidney failure care and payment is nonuniform in that the central and state governments often have different policies and approaches.24 HD is the dominant form of KRT.
Many employer-based insurance plans cover dialysis treatment, although some have annual coverage limits. State governments also provide insurance to their employees, and some states also have publicly funded dialysis programs under which
Central Asia: Mongolia
Ulaanbaatar, the capital and largest city, accounts for ~45% of Mongolia's population. Maintenance dialysis has been free for all since the beginning of 2017, though citizens need to take out health insurance. According to the national policy, all patients with kidney failure are eligible for KRT. The choice of HD versus PD is mainly a medical decision. There are 6 private HD units in Mongolia, while PD started in 2014 and there are currently fewer than 20 patients.
Western Asia (Middle East): Jordan
Both dialysis and transplantation are free for all Jordanians. Between 230 and 250 kidney transplantations are performed annually (all from living donors). A total of 4,500 kidney transplantations have been performed since 1972. During the past several years, the refugee crisis from neighboring Syria has challenged Jordan’s dialysis capacity. For the more than 500 KRT-dependent refugees from Syria, most dialysis sessions have been funded by nontraditional donors, such as diaspora NGOs and
Nephrologist Prevalence in Asia
Through this survey, we have also obtained information about the relative number of nephrologists in this part of the world (Fig 2). This information highlights a disparity in access to treatment and the availability of nephrologists across the Asian countries. Notably, the high-income countries tend to have the highest number of nephrologists per million population, followed by upper-middle income countries, and then the low-middle- and low-income countries. Among high- and upper-middle-income
Conclusion
This survey provides a deeper understanding of the burden of kidney failure and the process of care and payment in particular for dialysis patients in the described nations across Asia. Due to the varying socioeconomic and health care policies in the different regions of Asia, a diversity of payment systems exists. This dramatically affects quality of life and outcomes of patients with kidney failure in these regions. A great disparity is evident, explaining the huge variations in the
Article Information
Authors’ Full Names and Academic Degrees
Sydney C.W. Tang, MD, PhD, Xueqing Yu, MD, Hung Chun Chen, MD, PhD, Naoki Kashihara, MD, Hyeong Cheon Park, MD, PhD, Adrian Liew, MD, Bak Leong Goh, MD, FRCP, Maria Gina C. Nazareth, MD, Sakarn Bunnag, MD, Jackson Tan, MD, FRCP, Virithy Lun, MD, Aida Lydia, MD, PhD, Sanjib K. Sharma, MD, Ehteshamul Hoque, MD, Ariunaa Togtokh, MD, Mohammad Ghnaimet, MD, and Vivekanand Jha, MD.
Support
This study was supported by an Endowment Fund established for the Yu Professorship in Nephrology at the University of
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