Abstract
Introduction:72% of renal replacement therapy (RRT) clinics in Brazil are private. However, regarding payment for dialysis therapy, 80% of the patients are covered by the Unified Health System (SUS) and 20% by private healthcare (PH).Objectives:To evaluate costs for peritoneal dialysis (PD) and hemodialysis (HD) from the perspective of the service provider and compare with fund transfers from SUS and private healthcare.Methods:The absorption costing method was applied in a private clinic. Study horizon: January 2013 - December 2016. Analyzed variables: personnel, medical supplies, tax expenses, permanent assets, and labor benefits. The input-output matrix method was used for analysis.Results:A total of 27,666 HD sessions were performed in 2013, 26,601 in 2014, 27,829 in 2015, and 28,525 in 2016. There were 264 patients on PD in 2013, 348 in 2014, 372 in 2015, and 300 in 2016. The mean monthly cost of the service provider was R$ 981.10 for a HD session for patients with hepatitis B; R$ 238.30 for hepatitis C; R$197.99 for seronegative patients; and R$ 3,260.93 for PD. Comparing to fund transfers from SUS, absorption costing yielded a difference of -269.7% for hepatitis B, +10.2% for hepatitis C, -2.0% for seronegative patients, and -29.8% for PD. For PH fund transfers, absorption costing for hepatitis B yielded a difference of -50.2%, +64.24% for hepatitis C, +56.27% for seronegative patients, and +48.26 for PD.Conclusion:The comparison of costs of dialysis therapy from the perspective of the service provider with fund transfers from SUS indicated that there are cost constraints in HD and PD.
Highlights
The International Society of Nephrology[1] emphasized in a recent publication that chronic kidney disease (CKD) affects 850 million people worldwide and is one of the main contributors to the global burden from chronic non-communicable diseases (NCDs)
The study was conducted in a private clinic providing services in Juiz de Fora, including care to patients with CKD who are on conservative treatment, HD, peritoneal dialysis (PD), and pre- and post-renal transplant outpatient care, through s public healthcare system (SUS) and private healthcare (PH)
From 2013 to 2016, there were no adjustments in the payment by SUS for HD or PD sessions
Summary
The International Society of Nephrology[1] emphasized in a recent publication that chronic kidney disease (CKD) affects 850 million people worldwide and is one of the main contributors to the global burden from chronic non-communicable diseases (NCDs). CKD is both a cause and a consequence of NCDs and is the main cause of catastrophic health expenditure. The 2018 Brazilian dialysis census reported 133,464 patients on dialysis therapy (DT) in Brazil[2]. The Brazilian public health system, called the Unified Health System (Sistema Único de Saúde – SUS) was implemented in 1990 as a result of the last constitutional modification in 19883. With regard to private healthcare (PH), the Brazilian National Supplementary Health Agency (Agência Nacional de Saúde Suplementar) established in 1999 the rules for private health care plans and implemented basic guarantees for beneficiaries[4]. Regarding DT payment, 80% of patients are covered by the SUS and 20% by PH2
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