Induced demand in kidney replacement therapy. Issue 10 (October 2022)

• Record Type: Journal Article
• Authors: Redeker, Steef; Massey, Emma K.; van Merweland, Ruben G.; Weimar, Willem; Ismail, Sohal Y.; Busschbach, Jan J.V.
• Is Part Of: Health policy. Volume 126:Issue 10(2022)
• Page Start: 1062
• Page End: 1068
• Publication Date: 2022-10
• Subjects: Kidney replacement therapy -- Induced demand for healthcare services -- Dialysis -- Kidney transplantation; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2022.07.011
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: Current policy for patients with end-stage kidney disease is suboptimal. There is overutilization of in-center dialysis for patients with kidney failure. Capacity of in-center dialysis should be reduced. Financial disincentives of empty dialysis beds should be removed. Policy-makers should urge to change current policy. Abstract: There are three notable aspects of the current kidney replacement therapy program. First, the number of patients on home dialysis has dropped substantially over the last decades. Second, the rate of transplantation has stabilized in recent years. Third, there is variation in referral rate for transplantation among hospitals. These trends are the result of overutilization of in-center dialysis and that demand for kidney replacement therapy is moderated by suppliers. Current healthcare policy leads to overutilization of in-center dialysis and underutilization of home dialysis and transplantation. This overutilization is the result of supplier-induced demand and leads to suboptimal care for patients and excessive healthcare expenditures. The main drivers of this overutilization are the overcapacity of in-center dialysis beds and the high financial disincentives on empty dialysis beds. Policymakers should address this by reducing dialysis capacity and increasing the capacity of transplantation facilities. This is the first attempt to address the overutilization and the nonalignment of supply and demand by looking at the capacity of in-center dialysis and the financial disincentives for physicians on empty in-center dialysis beds. In our analysis, we conclude that limiting the capacity of in-center dialysis beds is the most effective strategy to better align supply and demand, which will result in better patient outcomes and lower societal costs.