title: The Japanese health-care system and reimbursement for dialysis.
abstract: Like most countries, Japan is facing constraints on expansion of health system financial resources. There are almost 250000 Japanese patients with end-stage renal disease and almost all are managed by chronic dialysis. Hospital hemodialysis is the modality used by 96% of these patients. The Japanese health-care system has tended to support resource-intensive treatments because the fee-for-service remuneration system has rewarded their utilization. This has benefited hemodialysis at the expense of peritoneal dialysis. However, this may now be changing. Case management and global budget-related approaches are being more widely introduced, as are incentives to reward more efficient treatment options. The relative costs of dialysis modalities are difficult to appreciate, as center-based services, such as hospital hemodialysis, are dependent upon fixed resources, while home-based options, such as peritoneal dialysis, are dependent upon variable resources. The aim of this review is to reconcile various sources of information relevant to end-stage renal disease funding in Japan. The review will suggest that modifying the approach to modality selection could lead to more efficient allocation of future dialysis-related resources and so reduce the strain on Japan's health-care budget.
authors.affiliation: Suzuka University of Medical Science, Suzuka, and Naito Medical Research Institute, Kobe, Japan. naito@kh.rim.or.jp
authors.forename: Hidemune
authors.initials: H
authors.lastname: Naito
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008875:Middle Aged; D012051:Reimbursement Mechanisms; D006435:Renal Dialysis / Q000191:economics*