The National Health Insurance Administration (NHIA) is considering including home hemodialysis in National Health Insurance (NHI) coverage, which could be added as early as May, NHIA Director-General Shih Chung-liang (石崇良) said yesterday.
Shih announced the plan at a conference on home healthcare in Taipei, held by Taipei Medical University and its affiliated hospitals.
Taiwan has been dubbed the “Kingdom of Dialysis” for many years, due to the high prevalence of people on dialysis, most of whom receive the treatment in hospitals or specialized clinics.
Photo: CNA
Shih said the plan for home hemodialysis coupled with telemedicine services had been approved in a recent NHI global budget meeting.
The plan would be further discussed in a Pharmaceutical Benefit and Reimbursement Scheme Joint Committee meeting later this month, and if approved, could take effect from May 1, he said.
Once enacted, hospitals and clinics would be required to submit plans to provide home hemodialysis and telemedicine services, he added.
The NHI has budgeted about NT$47.37 billion (US$1.44 billion) for dialysis this year, which would include home hemodialysis, as the treatment would not change, it would just be offered in a different location, Shih said.
Whether people on dialysis should purchase or rent equipment for the treatment would be further discussed, he added.
“The electricity used to power a four-hour hemodialysis at a specialized dialysis clinic can power a Tesla vehicle’s drive from Taipei to Kaohsiung,” said Taiwan Society of Nephrology secretary-general Hsu Yung-ho (許永和), who is also deputy superintendent of Taipei Municipal Wanfang Hospital.
Taiwan has abundant medical resources, and some people can receive peritoneal dialysis at home, but only 7 to 8 percent of them do, while more than 90 percent receive hemodialysis at a hospital or clinic, Hsu said, adding that with the development of smart medicine, the safety and feasibility of home hemodialysis would increase.
Limited by hospital or clinic scheduling, people can only receive hemodialysis up to three times per week and for four hours per session, but home hemodialysis offers more flexibility, enabling people to extend each session to six to eight hours, or reduce them to two to three hours per day, which studies have suggested is a better method for maintaining kidney function, he said.
In comparison with peritoneal dialysis, hemodialysis is more difficult to perform, so a medical team would first visit the person’s home to inspect the environment and instruct them on how to use the equipment, and later assist them through videoconferencing.
About half of the healthcare facilities that provide hemodialysis have the infrastructure for telemedicine services, while hospitals affiliated with Taipei Medical University use smart medicine technology to allow real-time monitoring of health data.
The system signals a warning when it detects abnormal readings, and can also use artificial intelligence to predict a person’s risk of low blood pressure, and remind them to adjust their treatment regimen or seek emergency aid at a hospital.
The real challenge in implementing the plan is changing people’s concept about healthcare, Hsu said.
Home hemodialysis can reduce the inconvenience of having to visit hospitals several times a week, while improving the efficiency of healthcare resources, but equipment costs remain a problem, which makes home treatment more suitable for people whose condition is stable and have the resources to afford the treatment, he said.
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