Impact of Private Health Insurance on Dialysis Outcomes - A Cohort Study

A. Sriravindrarajah, S. S. Kotwal, S. Sen, S. McDonald, A. Cass, M. Gallagher

    Research output: Contribution to journalMeeting AbstractResearch

    Abstract

    Aim: To understand the impact of private health insurance upon dialysis modality in Australia.

    Background: Re‐imbursement systems have been associated with differences in treatment modalities for patients receiving renal replacement therapy (RRT).

    Methods: All adult patients who commenced RRT in NSW between 2000‐2010 were identified using the Australia and New Zealand Dialysis and Transplant Registry. Data were linked to the state hospitalisation dataset to obtain insurance status, health service use, and mortality. Dialysis modality in the first year after starting RRT, dialysis access type, health service utilisation and mortality were compared between privately insured (PI) and public patients using appropriate statistical techniques.

    Results: PI patients were 38% (n=2152) of the 5737 patients in the study cohort. After adjustment for differences in baseline characteristics, PI patients were more likely to initiate RRT with in‐centre haemodialysis (OR 1.22, 95% CI 1.01‐1.46, P=0.03) and less likely to start with peritoneal dialysis (OR 0.81, 95% CI 0.67‐0.98, P=0.03). At one‐year after RRT initiation, PI patients were more likely to be receiving home haemodialysis (OR 1.38, 95% CI 1.01‐1.88, P=0.04) or to have been transplanted (OR 1.71, 95% CI 1.22‐2.40, P=0.002). PI patients were more likely to start haemodialysis with an arteriovenous fistula or graft (OR 1.91, 95% CI 1.50‐2.43, P=<0.001), used 15% fewer bed days in the first year after RRT commencement (IRR 0.85, 95% CI 0.74‐0.96, P=0.01) and had a lower mortality (HR 0.84, 95% CI 0.74‐0.95, P=0.01).

    Conclusions: Private health insurance in Australia is associated with higher use of home haemodialysis and transplantation at one year post RRT initiation. Sizeable differences in health service usage and outcomes in this group represent an equity challenge to renal services.
    Original languageEnglish
    Pages (from-to)18-18
    Number of pages1
    JournalNephrology
    Volume22
    Issue numberS3
    Early online date30 Aug 2017
    DOIs
    Publication statusPublished - 1 Sep 2017

    Fingerprint

    Health Insurance
    Renal Replacement Therapy
    Dialysis
    Cohort Studies
    Home Hemodialysis
    Health Services
    Renal Dialysis
    Mortality
    Transplants
    Insurance Coverage
    Arteriovenous Fistula
    Peritoneal Dialysis
    New Zealand
    Registries
    Hospitalization
    Transplantation
    Kidney

    Cite this

    Sriravindrarajah, A., Kotwal, S. S., Sen, S., McDonald, S., Cass, A., & Gallagher, M. (2017). Impact of Private Health Insurance on Dialysis Outcomes - A Cohort Study. Nephrology, 22(S3), 18-18. https://doi.org/10.1111/nep.13104
    Sriravindrarajah, A. ; Kotwal, S. S. ; Sen, S. ; McDonald, S. ; Cass, A. ; Gallagher, M. / Impact of Private Health Insurance on Dialysis Outcomes - A Cohort Study. In: Nephrology. 2017 ; Vol. 22, No. S3. pp. 18-18.
    @article{14471cb20e7541d39b2d3e14ebe22a22,
    title = "Impact of Private Health Insurance on Dialysis Outcomes - A Cohort Study",
    abstract = "Aim: To understand the impact of private health insurance upon dialysis modality in Australia. Background: Re‐imbursement systems have been associated with differences in treatment modalities for patients receiving renal replacement therapy (RRT). Methods: All adult patients who commenced RRT in NSW between 2000‐2010 were identified using the Australia and New Zealand Dialysis and Transplant Registry. Data were linked to the state hospitalisation dataset to obtain insurance status, health service use, and mortality. Dialysis modality in the first year after starting RRT, dialysis access type, health service utilisation and mortality were compared between privately insured (PI) and public patients using appropriate statistical techniques. Results: PI patients were 38{\%} (n=2152) of the 5737 patients in the study cohort. After adjustment for differences in baseline characteristics, PI patients were more likely to initiate RRT with in‐centre haemodialysis (OR 1.22, 95{\%} CI 1.01‐1.46, P=0.03) and less likely to start with peritoneal dialysis (OR 0.81, 95{\%} CI 0.67‐0.98, P=0.03). At one‐year after RRT initiation, PI patients were more likely to be receiving home haemodialysis (OR 1.38, 95{\%} CI 1.01‐1.88, P=0.04) or to have been transplanted (OR 1.71, 95{\%} CI 1.22‐2.40, P=0.002). PI patients were more likely to start haemodialysis with an arteriovenous fistula or graft (OR 1.91, 95{\%} CI 1.50‐2.43, P=<0.001), used 15{\%} fewer bed days in the first year after RRT commencement (IRR 0.85, 95{\%} CI 0.74‐0.96, P=0.01) and had a lower mortality (HR 0.84, 95{\%} CI 0.74‐0.95, P=0.01). Conclusions: Private health insurance in Australia is associated with higher use of home haemodialysis and transplantation at one year post RRT initiation. Sizeable differences in health service usage and outcomes in this group represent an equity challenge to renal services.",
    keywords = "Urology & Nephrology",
    author = "A. Sriravindrarajah and Kotwal, {S. S.} and S. Sen and S. McDonald and A. Cass and M. Gallagher",
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    Sriravindrarajah, A, Kotwal, SS, Sen, S, McDonald, S, Cass, A & Gallagher, M 2017, 'Impact of Private Health Insurance on Dialysis Outcomes - A Cohort Study', Nephrology, vol. 22, no. S3, pp. 18-18. https://doi.org/10.1111/nep.13104

    Impact of Private Health Insurance on Dialysis Outcomes - A Cohort Study. / Sriravindrarajah, A.; Kotwal, S. S.; Sen, S.; McDonald, S.; Cass, A.; Gallagher, M.

    In: Nephrology, Vol. 22, No. S3, 01.09.2017, p. 18-18.

    Research output: Contribution to journalMeeting AbstractResearch

    TY - JOUR

    T1 - Impact of Private Health Insurance on Dialysis Outcomes - A Cohort Study

    AU - Sriravindrarajah, A.

    AU - Kotwal, S. S.

    AU - Sen, S.

    AU - McDonald, S.

    AU - Cass, A.

    AU - Gallagher, M.

    PY - 2017/9/1

    Y1 - 2017/9/1

    N2 - Aim: To understand the impact of private health insurance upon dialysis modality in Australia. Background: Re‐imbursement systems have been associated with differences in treatment modalities for patients receiving renal replacement therapy (RRT). Methods: All adult patients who commenced RRT in NSW between 2000‐2010 were identified using the Australia and New Zealand Dialysis and Transplant Registry. Data were linked to the state hospitalisation dataset to obtain insurance status, health service use, and mortality. Dialysis modality in the first year after starting RRT, dialysis access type, health service utilisation and mortality were compared between privately insured (PI) and public patients using appropriate statistical techniques. Results: PI patients were 38% (n=2152) of the 5737 patients in the study cohort. After adjustment for differences in baseline characteristics, PI patients were more likely to initiate RRT with in‐centre haemodialysis (OR 1.22, 95% CI 1.01‐1.46, P=0.03) and less likely to start with peritoneal dialysis (OR 0.81, 95% CI 0.67‐0.98, P=0.03). At one‐year after RRT initiation, PI patients were more likely to be receiving home haemodialysis (OR 1.38, 95% CI 1.01‐1.88, P=0.04) or to have been transplanted (OR 1.71, 95% CI 1.22‐2.40, P=0.002). PI patients were more likely to start haemodialysis with an arteriovenous fistula or graft (OR 1.91, 95% CI 1.50‐2.43, P=<0.001), used 15% fewer bed days in the first year after RRT commencement (IRR 0.85, 95% CI 0.74‐0.96, P=0.01) and had a lower mortality (HR 0.84, 95% CI 0.74‐0.95, P=0.01). Conclusions: Private health insurance in Australia is associated with higher use of home haemodialysis and transplantation at one year post RRT initiation. Sizeable differences in health service usage and outcomes in this group represent an equity challenge to renal services.

    AB - Aim: To understand the impact of private health insurance upon dialysis modality in Australia. Background: Re‐imbursement systems have been associated with differences in treatment modalities for patients receiving renal replacement therapy (RRT). Methods: All adult patients who commenced RRT in NSW between 2000‐2010 were identified using the Australia and New Zealand Dialysis and Transplant Registry. Data were linked to the state hospitalisation dataset to obtain insurance status, health service use, and mortality. Dialysis modality in the first year after starting RRT, dialysis access type, health service utilisation and mortality were compared between privately insured (PI) and public patients using appropriate statistical techniques. Results: PI patients were 38% (n=2152) of the 5737 patients in the study cohort. After adjustment for differences in baseline characteristics, PI patients were more likely to initiate RRT with in‐centre haemodialysis (OR 1.22, 95% CI 1.01‐1.46, P=0.03) and less likely to start with peritoneal dialysis (OR 0.81, 95% CI 0.67‐0.98, P=0.03). At one‐year after RRT initiation, PI patients were more likely to be receiving home haemodialysis (OR 1.38, 95% CI 1.01‐1.88, P=0.04) or to have been transplanted (OR 1.71, 95% CI 1.22‐2.40, P=0.002). PI patients were more likely to start haemodialysis with an arteriovenous fistula or graft (OR 1.91, 95% CI 1.50‐2.43, P=<0.001), used 15% fewer bed days in the first year after RRT commencement (IRR 0.85, 95% CI 0.74‐0.96, P=0.01) and had a lower mortality (HR 0.84, 95% CI 0.74‐0.95, P=0.01). Conclusions: Private health insurance in Australia is associated with higher use of home haemodialysis and transplantation at one year post RRT initiation. Sizeable differences in health service usage and outcomes in this group represent an equity challenge to renal services.

    KW - Urology & Nephrology

    U2 - 10.1111/nep.13104

    DO - 10.1111/nep.13104

    M3 - Meeting Abstract

    VL - 22

    SP - 18

    EP - 18

    JO - Nephrology

    JF - Nephrology

    SN - 1320-5358

    IS - S3

    ER -

    Sriravindrarajah A, Kotwal SS, Sen S, McDonald S, Cass A, Gallagher M. Impact of Private Health Insurance on Dialysis Outcomes - A Cohort Study. Nephrology. 2017 Sep 1;22(S3):18-18. https://doi.org/10.1111/nep.13104