Changing of dialysis policy in Thailand
In 2022, Thailand changed its national dialysis policy from a Peritoneal Dialysis (PD) First model to Patient-Led Dialysis. This improvement aimed to allow patients to choose their preferred dialysis modality (HD or PD) based on individual clinical needs and lifestyle preferences without additional financial burdens. The goal was to move away from a “one-size-fits-all” approach and increase patient safety by reducing the morbidity and mortality risks sometimes associated with forced PD in unsuitable candidates.
However, recent reports have shown that this policy has significant barriers, leading to unintended consequences for both patients (e.g. worse clinical outcomes from poorly planned initiation) and the health system (e.g. over-dialysis and the neglect of home-based PD). The barriers include:
– Informatics Barrier: A lack of interoperability between hospitals, private HD providers, and the budget payer’s database (NHSO-National Health Security Service). This makes it difficult to monitor real-time efficiency or track patient outcomes across different stakeholders
– Workforce Constraints: The increase in demand for HD has led to a shortage of specialized healthcare professionals, which affected the quality of treatment
– Financial Sustainability: This affected the Universal Coverage Scheme budget, as HD is significantly more expensive for the health system to maintain than home-based PD
– Incentive Bias: Private clinics may prioritize HD sessions for revenue generation, which could lead to over-dialysis for unsuitable candidates
Ref: https://www.nature.com/articles/s41591-025-04084-w
https://www.hitap.net/en/document/policy-brief-191-sustainable-kidney-replacement-thailand-2022-reform/