The Impact of the Point-Value Guarantee under Global Buget System on the Choice of Different Dialsysis Treatments

It is a long concern academically and politically that Taiwan has high prevalence rate and incidence rate for End-stage renal diseases (ESRD). This high prevalence rate and high incidence rate are also one of major reasons for the increasing growth of related health expenditure. Though the global budget cap has been set up for ESRD related treatments in year 2003, it is believed that the average cost of using peritoneal dialysis is lower than that of using hemo-dialysis. Therefore, in the year 2006 and 2007, the Taiwan’s Bureau of National Health Insurance guaranteed that the point-value of per peritoneal dialysis is $1 after year 2006, and $1.2 after 2007. This guarantee of point values creates a financial incentive for all dialysis providers to use a relative profitable treatment. This study is trying to estimate the impact of this PD point-value guarantee on the usage of dialysis treatments. The data is from National Health Insurance research dataset. We first begin from new dialysis patient. We are going to estimate the probability of being treated by peritoneal dialysis for new dialysis. If the policy has impact on the usage of peritoneal dialysis, this probability should be increased after the policy of point-value guarantee. Secondly, we are going to estimate the probability of treatment conversion for an existing ESRD patient who are treated initially by hemo-dialysis. Specifically, we are going to estimate the probability of a patient who convert his/her treatment from hemo-dialysis to peritoneal dialysis after two PD point-value guarantee in 2006 and 2007. Lastly, using generalized linear method (GLM) and employing estimation strategy of difference-in-difference(DID), we are going to estimate the growth rate of PD usage related to that of HD usage. The treatment group is dialysis providers who provide both of PD and HD treatment before and after policy. The observations in control group are providers who never provide PD treatments.

Project ID:PF10207-0420
External Project ID:NSC102-2410-H182-009