ArticleFrontiers in public health2022
The hidden financial catastrophe of chronic kidney disease under universal coverage and Thai "Peritoneal Dialysis First Policy".
Article in Frontiers in public health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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15 citing papers in PubMed, 14 citations in OpenAlex.
- Beyond free healthcare: household out-of-pocket expenditure and catastrophic health expenditure among chronic kidney disease patients attending a tertiary care hospital in Sri Lanka.BMC health services research · 2026Article
- Outcomes and Trade-offs of Thailand's 2022 Patient-Choice Dialysis Policy Reform.Kidney international reports · 2026Article
- Single-center cross-sectional study of outcomes in hemodialysis patients in Niger: experience from the hemodialysis center at Zinder National Hospital.BMC nephrology · 2026Article
- Health-related quality of life in patients on maintenance hemodialysis: Evidence from southern Iran using EQ-5D-5L and KDQOL-SF.PloS one · 2026Article
- Nature Medicine Commission on dialysis policy in low- and middle-income countries.Nature medicine · 2026Article
- Comparative Assessment of Out-of-Pocket Health Expenditure in Haemodialysis and Peritoneal Dialysis Patients.Healthcare (Basel, Switzerland) · 2025Article
- Article
- The catastrophic costs of chronic kidney disease.Nature reviews. Nephrology · 2025Article
- Quality of Life in Patients with CKD With Catastrophic Health Care Expenditures: A National Study From Thailand.Kidney medicine · 2025Article
- Article
- Financial Toxicity and Kidney Disease in Children and Adults: A Scoping Review.International journal of nephrology and renovascular disease · 2025Review
- Patient survival and kidney transplantation in different dialysis modalities under PD First Policy Thailand.PloS one · 2025Article
- Financial Toxicity in Renal Patients (FINTORE) Study: A Cross-Sectional Italian Study on Financial Burden in Kidney Disease-A Project Protocol.Methods and protocols · 2024Article
- Capacity for the management of kidney failure in the International Society of Nephrology Eastern and Central Europe region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA).Kidney international supplements · 2024Review
- Landscape of kidney replacement therapy provision in low- and lower-middle income countries: A multinational study from the ISN-GKHA.PLOS global public health · 2024Article
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Authors and funding
18 authors at 11 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Objective: Universal health coverage can decrease the magnitude of the individual patient's financial burden of chronic kidney disease (CKD), but the residual financial hardship from the patients' perspective has not been well-studied in low and middle-income countries (LMICs). This study aimed to evaluate the residual financial burden in patients with CKD stage 3 to dialysis in the "PD First Policy" under Universal Coverage Scheme (UCS) in Thailand. Methods: This multicenter nationwide cross-sectional study in Thailand enrolled 1,224 patients with pre-dialysis CKD, hemodialysis (HD), and peritoneal dialysis (PD) covered by UCS and other health schemes for employees and civil servants. We interviewed patients to estimate the proportion with catastrophic health expenditure (CHE) and medical impoverishment. The risk factors associated with CHE were analyzed by multivariable logistic regression. Results: Under UCS, the total out-of-pocket expenditure in HD was over two times higher than PD and nearly six times higher than CKD stages 3-4. HD suffered significantly more CHE and medical impoverishment than PD and pre-dialysis CKD [CHE: 8.5, 9.3, 19.5, 50.0% ( Conclusions: Despite universal coverage, the residual financial burden remained high in patients with kidney failure. CHE was considerably lower in PD than HD, although the rates remained alarmingly high in the poor. The "PD First' program" could serve as a model for other LMICs. However, strategies to minimize financial distress should be further developed, especially for the poor.
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