[Impact of health insurance type on the quality of hemodialysis services: a multilevel analysis].
OBJECTIVE
This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid.


METHODS
This study used data from sampled hospitals that provided a hemodialysis service. A total of 2,287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time, erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as: hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best).


RESULTS
There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI=0.43-0.99). However, frequency of hemodialysis, hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb >or= 11 g/dL, blood pressure within the range of 100-140/60-90 mmHg, calcium x phosphate <or= 55 g(2)/dL(2) and albumin >or= 4 g/dL were not significantly different between the groups.


CONCLUSIONS
There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis.
Jung
Jin Hee
JH
Health Insurance Review & Assessment Service, Seoul, Korea.
Kwon
Soon Man
SM
Kim
Kyoung Hoon
KH
Lee
Seon Kyoung
SK
Kim
Dong Sook
DS
D000368:Aged; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000145:classification*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D006435:Renal Dialysis / Q000592:standards*; D056910:Republic of Korea