The organization and financing of dialysis and kidney transplantation services in New Zealand
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The organization and financing of dialysis and kidney transplantation services in New Zealand Toni Ashton · Mark Roger Marshall
Published online: 19 July 2007 © Springer Science+Business Media, LLC 2007
Abstract In New Zealand, patients receive treatment for end-stage renal disease (ESRD) within the tax-funded health system. All hospital and specialist outpatient services are free, while general practitioner consultations and pharmaceuticals prescribed outside of hospitals incur copayments. Total ESRD prevalence is 0.07%, half the U.S. rate, and the prevalence of home-based and self-care dialysis is the highest in the world. Medical staff are not subject to direct financial incentives that could affect treatment choice. Estimated total expenditure per ESRD patient is relatively low. Funding constraints encourage physicians and patients to consider the probable benefit of dialysis for a patient before treatment is prescribed. Keywords End-stage renal disease · Dialysis · Health care financing · Medical Costs · Reimbursement · New Zealand JEL Classification I10 · I11 · I12 · I18
Introduction In New Zealand, citizens or permanent residents of New Zealand (and its dependencies Nuie, the Cook Islands, and Tokolau) receive treatment for end-stage renal disease (ESRD) within the tax-funded public health system in the same way as patients with other medical needs. Tax funds are allocated to 21 District Health Boards (DHBs) by the government on a weighted
T. Ashton (B) Health Economics, Centre for Health Services Research and Policy, School of Population Health, University of Auckland, Auckland, New Zealand e-mail: [email protected] M. R. Marshall Department of Renal Medicine, Middlemore Hospital, Otahuhu, Auckland, New Zealand
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capitation basis for the population living in their district. The DHBs then use these funds to either purchase services from private providers or directly provide services for the population residing within their geographically defined area. Services directly provided by the DHBs are free of charge. They include all secondary and tertiary hospital services, as well as a range of community-based services, including home-based hemodialysis. Any pharmaceuticals prescribed and directly dispensed from a hospital pharmacy to inpatients or outpatients in a hospital setting are also fully subsidized by the government. These conditions apply to all patients, including ESRD patients. In contrast, primary health care is only partially subsidized by the government. Therefore patients must pay copayments in the range of NZ$0–$50 (US$0-33; PPP 2004) for services provided by general practitioners (GPs). Copayments also apply to all pharmaceuticals dispensed by community pharmacies, regardless of whether they are prescribed in a hospital outpatient setting or by a GP, and regardless of whether or not the treatment is related to kidney disease. However, laboratory tests are provided under the public health system free of charge. The supply of primary health services is a
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