Dialysis Treatment Improvement
Why THRF Advocate It?
The number of dialysis patient continues to increase in Taiwan, but the care itself is suffering from various budget and managerial crises. According to the Bureau of National Health Insurance (BHNI), more than 20 billion NT ($600 billion) were spent on dialysis coverage on the yearly bases. Unfortunately, the government旧 overt reliance on spending not only failed to improve the dialysis care standard, but also draining the National Health Insurance (NHI). The following are several our key observations on the flaws within Taiwan旧 dialysis care system:
1. The NHI reimburses both used and new artificial kidneys (AK) at the same price, which creates unnecessary waste on the healthcare budget. A research done by the Taiwanese Dialysis Patients Association shows that more than 40% hemodialysis facilities reuse AK, which means if an artificial kidney was used, say, six times, the facility receive five extra reimbursements. 
2. More than 12 billion NTD (around $3.7 billion) budget was put into dialysis care; however, lack of regulation and supervision on the budget spending has made it (the budget) easily fell victim to different kinds of exploitation. According to a sampling survey conducted by the Taiwanese Dialysis Patients Association on December 2004, there is no regulation on reusing the one-use only AK in Taiwan, and 7 out 17 medical centers surveyed reused the AKs 6 times in average without doing TCV test. 
3. Instead of addressing problems of managerial deficiency, the Department of Health relied on scaling down insurance coverage to solve budget deficit of the dialysis care, which has greatly marginalized the care quality. Moreover, due to the lack of feedback mechanism and the opportunity of institutional participation, the patients are unable to voice their opinions about the care they received.
The Taiwan Healthcare Reform Foundation launched a press conference at December 2004 to address the issues. The followings are our main advocacies:
1. The Department of Health (DOH) should enact a guideline for AK reuse. The guideline should outline the index of the quality of hemodialysis treatment, and the standard operation procedure and requirement for AK reuse. The BNHI should suspend the contracts with the dialysis facilities that fail to follow the guideline.
2. BNHI should differentiate the reimbursement plans for the new and used equipments such as AKs.
3. DOH should develop a feedback mechanism for the dialysis patients allowing their opinions to take a part in the policy making process.
4. The government should also help patients to understand the reuse requirement for AK, such as under what condition could this equipment be reused and what adverse affect it might cause. Through education, we hope the patient would be able to protect their interest, at the same time cooperate with the medical staff during the care. Also, the patient should also be given a chance to decide whether to receive the treatment with used equipments.
5. We suggest the government conduct a thorough study on the reuse of AKs, verifying under what conditions different type of AK could be reused. Qualified manufacturer should be licensed through a carefully supervised process. All these information needed to be disclosed to the public, with each AK clearly labeled.
The Bureau of National Health Insurance held a meeting to discuss about the payment standard of dialysis treatment at February 2005. But there was no concrete policy reform carried out. The Taiwan Health Reform Foundation is still preparing for further advocacy on this issue.
 Taiwanese Dialysis Association, 2004.
 To safeguard the quality of dialysis treatment in America where reusing is common, an AK can be reused only under the conditions that its total cell volume (TCV) was above 80% under the prescription of the AAMI gusidelines on reusing AK.