Impact of supplemental private health insurance on dialysis and outcomes

Abstract

AIM:The influence of health insurance systems upon the treatment of end-stage kidney disease (ESKD) patients is poorly understood. We investigated how supplemental private health insurance (PHI) coverage impacted upon ESKD treatment modalities and patient outcomes. METHODS:All adult patients commencing ESKD treatment in New South Wales, Australia from 2000 to 2010 were identified using the Australia and New Zealand Dialysis and Transplant Registry. Data were linked to the state hospitalisation dataset to obtain insurance status, allowing the comparisons of mortality, ESKD treatment modality and health service utilisation between privately insured and public patients. RESULTS:The cohort of 5,737 patients included 38% (n=2,152) with PHI. At one-year after ESKD treatment initiation, PHI patients had lower mortality (HR 0.84, 95% CI 0.74-0.95, P=0.01), were more likely to be receiving home haemodialysis (OR 1.38, 95% CI 1.01-1.89, P=0.04), to have been transplanted (OR 1.75, 95% CI 1.25-2.46, P=0.001), and used fewer hospital days (IRR 0.85, 95% CI 0.74-0.96, P=0.01)After adjustment, PHI patients were more likely to initiate ESKD treatment with facility-based haemodialysis (OR 1.22, 95% CI 1.01-1.46, P=0.03), but were less likely to start on peritoneal dialysis (OR 0.81, 95% CI 0.67-0.98, P=0.03).. CONCLUSION:Our findings suggest that supplemental PHI in Australia is associated with lower risk ESKD treatment attributes and improved health outcomes. Greater understanding of the treatment pathways that deliver these outcomes may inform treatment for the broader ESKD treatment population. This article is protected by copyright. All rights reserved.