Nature Portfolio Commissions: Data-Driven Solutions for Global Challenges
- Thailand's Universal Health Coverage (UHC) scheme, implemented in 2001, has expanded access to healthcare and reduced out-of-pocket expenses for citizens, demonstrating positive results on UHC-related Sustainable Development...
- From 2008 to 2022, Thailand prioritized home-based peritoneal dialysis (PD) for most patients, reserving clinic-based hemodialysis (HD) for those with medical contraindications.This 'PD-first' strategy was internationally recognized as...
- The liberalization of dialysis modality choice led to a substantial and unexpected increase in the number of new patients opting for HD.
Thailand’s Worldwide Health Coverage and Dialysis Policy: A Commission Report
Table of Contents
Thailand’s Universal Health Coverage (UHC) scheme, implemented in 2001, has expanded access to healthcare and reduced out-of-pocket expenses for citizens, demonstrating positive results on UHC-related Sustainable Development Goal indicators. the nation is among a limited number of low- and middle-income countries (LMICs) that have incorporated dialysis policy into its UHC program.
The ‘PD-First‘ Approach and Subsequent Policy Shift
From 2008 to 2022, Thailand prioritized home-based peritoneal dialysis (PD) for most patients, reserving clinic-based hemodialysis (HD) for those with medical contraindications.This ‘PD-first’ strategy was internationally recognized as a model for sustainable dialysis policy. However,a policy change in 2022 allowing patients to choose between PD and HD resulted in unforeseen negative consequences.
Unintended Consequences of Patient Choice
The liberalization of dialysis modality choice led to a substantial and unexpected increase in the number of new patients opting for HD. This surge in HD utilization was accompanied by a corresponding rise in healthcare costs and, critically, an increase in mortality rates among patients initiating HD. Data from the Nature Medicine Commission Report details these outcomes.
Commission Objectives and Global Implications
A commission comprised of Thai and international experts was convened to address the challenges arising from the revised dialysis policy. the commission’s work aims to provide solutions for Thailand’s ongoing dialysis policy issues and to offer valuable insights for other countries seeking to broaden access to dialysis within their own UHC frameworks. The findings are published in Nature Medicine.