Big difference in treatment for kidney patients in three schemes

[Lite Beer]

Big difference in treatment for kidney patients in three schemes
THE SUNDAY NATION

BANGKOK: -- DEBATE is raging on over differences in quality and unequal treatment under the country's three healthcare schemes.

Dr Surasak Kantachuvesiri, a kidney expert at Mahidol University's Ramathibodi Hospital, has claimed that there was a rather high fatality rate among kidney disease patients under the Universal Coverage Scheme (UCS) because the scheme limits patients to undergo peritoneal dialysis first. The Social Security Scheme (SSS), meanwhile, was worse, he said, as kidney patients must first cover treatment costs of about Bt30,000 per month for up to three months until their coverage is approved. Surasak said they also have to cover the Bt6,000 per month expense of dialysis liquid.

Khon Kaen University kidney disease division chief Dr Thawee Siriwong has argued that the fatality rate of kidney patients covered by UCS who undergo dialysis is within international standards. He said most patients were ailing elderly people, so their risk level was already high. Treatment provided under the universal scheme helped prolong patients' lives compared to before 2008, when poor patients in the last phase of the disease did not have access to treatment, hence the high death rate.

Thawee admitted that UCS patients were at a higher risk than those under the other two schemes, as most SSS subscribers were of working age and healthier, while those under the Civil Servant Medical Benefit Scheme (CSMBS) were better off financially.

Thawee said the UCS fund for chronic kidney disease, as far as he knew, was mostly spent on buying dialysis liquid for patients and the rest on system development and human resources.

As a doctor taking care of kidney patients for a long time, he said, the universal scheme gave people better access to treatment and some 50 to 60 per cent of patients in the last phase of the disease had access to treatment. He said use of peritoneal dialysis had been introduced due to budget and manpower restraints, though this approach ensured that last-phase chronic kidney disease patients were taken care of.

Surasak said both peritoneal dialysis and haemo-dialysis yielded good results and prolonged the patients' life span, while noting that a patient's treatment depends much on a doctor's diagnosis.

Subscribers to CSMBS have greater benefits, as patients are treated according to a doctor's diagnosis and the reimbursement matches the actual amount of the bill, Surasak said. On the other hand, UCS patients need to undergo peritoneal dialysis even if their condition does not require it, hence the result can sometimes be inferior to patients under CSMBS, he said.

UCS patients also face a higher risk of infection because they are mostly elderly who are unable to conduct dialysis cleanly at home, Surasak said. Surasak said UCS subscribers found to be unable to use peritoneal dialysis - such as those who have been infected in their stomach several times and their peritoneum can no longer support the dialysis method - would be eligible for haemo-dialysis.

"However, the problem has to arise first before the treatment method can be changed," he added.

Meanwhile, the SSS had the greatest drawbacks , compared to the other two schemes, Surasak said.

SSS patients have to wait three months to get approval for reimbursement from a medical committee. While they wait, the patients have to cover monthly medical expenses of up to Bt30,000, he said.

Also, an average-sized person requires four bags of dialysis liquid, while a larger person needs five to six bags, he said. CSMBS covers the expense of all the bags, but the UCS only covers four bags a day and SSS covers three bags. Hence, if a patient has to buy an extra bag daily, the expense could amount to Bt6,000 a month, he said.

Source: http://www.nationmultimedia.com/national/Big-difference-in-treatment-for-kidney-patients-in-30264740.html

-- The Nation 2015-07-19

[noitom]

Thais have figured all this out - amazing.

[jaywalker]

Why don't they just say scam instead of scheme?

[SOTIRIOS]

...dreadful....

...try to stay healthy and away from doctors....at all costs....

....look up: iatrogenics .............

[ksamuiguy]

Sad and disappointing, charge the most to the least able to afford the treatment and make that treatment to lower standard than those under a better scheme. SAD!

[HiSoLowSoNoSo]

I am not very confident in their dialysis methods after losing one of my workers, a 27 year old Thai man after only 4 weeks of dialysis treatment. First plane to Singapore or Europe for me if I would get a kidney problem here.

[sammygood]

i would be scared to use such a machine here, just to save costs, they might not clean from previous person and then you die just a little faster by infection

[Traveling Sailor]

"Surasak said both peritoneal dialysis and haemo-dialysis yielded good results and prolonged the patients' life span, while noting that a patient's treatment depends much on a doctor's diagnosis."

Based on what I have witnessed in the 5 years that I have been here, unless a Thai doctor does some training outside of Thailand, their diagnostic skills are almost non-existant. No doctor that I have had any dealings with,either for myself or a Thai friend, south of Bangkok, has shown even the slightest ability to diagnose. This includes an "International" hospital on Phuket island. Also, the Thai doctors that I have met have no inclination to colaborate, consult with other doctors or give a crap about finding a cure for a patient.

If anyone knows of a hospital south of Bangkok that employs doctors who really know how to diagnose, I would love to get the name of the hospital and the doctor.

Edited July 20, 2015 by Traveling Sailor

[aussieinthailand]

Here's a little heads up people, Kidney disease is not always ezy to diagnose, For many people you don't know until it's to late, (to late) what does that mean?

There are 5 stages of Kidney disease, stage 5 is the final stage and you can be ok and fine and the next your are in ICU and tubes down your thought nose, in your arm with monitors all over, Many people are lucky and can have symptoms present much earlier and with diet and med's can prolong the progression of the disease. So often not the fault of the person with a sudden onset of symptoms.

IMO The whole system needs a major overhaul, Incompetency/corruption??? half the time the patient can't get the correct amount of fluid needed for the month and has to beg borrow from other people in your area and if still no, back too hospital to pick 1/2 days treatment fluid until you get delivery.

people are making money from the sick and dying. The hemo-dialysis treatment is not available in privet (in home) use in Thailand.

The Hemodialysis is ok but older tech, it causes problems with blood pressure, dizziness fatigue etc, your water intake is 500/600 mils per day hot or cool weather so in the heat you mostly take ice to drink as it melts in your mouth, any more back too ICU........ you must have in hospital treatment 4 times a week at a coast between 2500-3500 per plus injections at an extra, plus waiting time and the drive too hospital etc.

Peritoneal dialysis gives a much better health outlook and a better quality of life, as your diet is not quite as restricted nor your water intake.

Cleanliness to avoid infections is key, A dedicated treatment only room, no curtains no fans, dust free, a sink, storage for equipment, somewhere to lay down special medical equipment and injections every month, but at least your at home and can function almost normally as time for treatment is aprox 45 min's 4 times per day.

Also neither of these treatments are a cure, they simply to manage the disease as it progresses, your best hope for a few extra years life expectancy is transplant, with all the risks that involves.

Now let me tell you trying to get onto the list is no ezy task and the life expectancy is better than no transplant so..... Now what?

Time to jump through those flaming hoops again, and get some padding for your head and the brick wall cause you 2 will be back at it once again.

The cost can be lowered, ie the fluid used, it's water, glucose and calcium, the delivery system can be lowered, it's all plastic but can be re-designed and or alternate materials used? so someone out there with the right skills can re-jack this stuff then there's a GLOBAL opportunity out there as it would lower the health costs to people all over the world and public health care would be on it like a fat kid on a cup cake.

How do I know all this? Well lets just say I see it 4 times a day.

My wife and I recently spent 10 day's in Japan on holiday and treatment went off without a hitch.

Edited July 20, 2015 by aussieinthailand