A Survey of Home Enteral Nutrition Practices and Reimbursement in the Asia Pacific Region.

Alvin Wong,Judith Bauer,Merrilyn Banks

doi:10.3390/nu10020214

Alvin Wong, Judith Bauer + Show 1 more

Open Access

https://doi.org/10.3390/nu10020214

Copy DOI

Abstract

Literature regarding the use of home enteral nutrition (HEN) and how it is reimbursed in the Asia Pacific region is limited. This research survey aims to determine the availability of HEN, the type of feeds and enteral access used, national reimbursement policies, the presence of nutrition support teams (NSTs), and clinical nutrition education in this region. An electronic questionnaire was sent to 20 clinical nutrition societies and leaders in the Asia Pacific region in August 2017, where thirteen countries responded. Comparison of HEN reimbursement and practice between countries of different income groups based on the World Bank’s data was investigated. Financial support for HEN is only available in 40% of the countries. An association was found between availability of financial support for HEN and health expenditure (r = 0.63, p = 0.021). High and middle-upper income countries use mainly commercial supplements for HEN, while lower-middle income countries use mainly blenderized diet. The presence of NSTs is limited, and only present mainly in acute settings. Sixty percent of the countries indicated an urgent need for funding and reimbursement of HEN. This survey demonstrates the varied clinical and economic situation in the Asia Pacific region. There is a lack of reimbursement, clinical support, and inadequate educational opportunities, especially for the lower-middle income countries.

Highlights

Home enteral nutrition (HEN) is a life-saving and life-sustaining therapy for patients who are unable to obtain adequate nutrition via the oral route
An early study in the United States reported the cost of home enteral nutrition, including feeds, supplies, and care, and one hospitalization stay to range from USD $5000 to $50,000 [5]
Participants of the survey included dietitians and medical doctors who are experienced in HEN practice, or members of the respective Parenteral and Enteral Nutrition (PEN) societies

Summary

Introduction

Home enteral nutrition (HEN) is a life-saving and life-sustaining therapy for patients who are unable to obtain adequate nutrition via the oral route. Artificial Nutrition Survey (BANS) reported a 5% increment in HEN between 2009 and 2010, with an incidence of 55 per million population and point prevalence of 92 per million population [1]. An early study in the United States reported the cost of home enteral nutrition, including feeds, supplies, and care, and one hospitalization stay to range from USD $5000 to $50,000 [5]. This price is likely to have increased in recent years, it is generally difficult to obtain expenditure information given differences in insurance coverage and reimbursement. Reimbursement for enteral nutrition has been made available to patients in the United States and some European nations

Objectives

Methods

Results

Conclusion