The impact of country reimbursement programmes on living kidney donations
The impact of country reimbursement programmes on living kidney donations
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DOI：
10.1136/bmjgh-2020-002596
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发表时间：
2020-08-01
影响因子：
8.1
通讯作者：
Koizumi, Naoru
中科院分区：
文献类型：
--
作者：
Siddique, Abu Bakkar;Apte, Vandana;Koizumi, Naoru
介绍活体供肾移植是终末期肾病患者的金标准治疗。然而，潜在的捐助者普遍面临财政和后勤障碍。为了消除活体肾脏捐赠的这些抑制因素，23个国家的政府实施了报销计划，将非医疗费用的负担从捐赠者转移到政府或私人实体。然而，这些方案有效性的科学证据很少。本研究调查了这些旨在缓解财政和后勤障碍的报销方案是否成功地增加了国家一级的活体肾脏捐赠数量。该研究审查了国家内部在这类偿还方案的时间安排方面的差异。该研究应用泊松分布的差异中差异（双向面板固定效应）技术，以估计这些报销计划对17年（2000-2016年）数据集的影响，该数据集涵盖109个进行活体供肾移植的国家。结果研究结果表明，补偿方案有统计学上显着的积极影响。总的来说，该模型预测，偿还方案使国家一级的捐助数量增加了1.12-1.16倍。结论肾资源补偿项目是缓解全球肾资源短缺的有效途径。需要进一步分析偿还方案的类型以及每类方案的道德方面。
Introduction Living-donor kidney transplantation is the gold standard treatment for patients with end-stage kidney disease. However, potential donors ubiquitously face financial as well as logistical barriers. To remove these disincentives from living kidney donations, the governments of 23 countries have implemented reimbursement programmes that shift the burdens of non-medical costs from donors to the governments or private entities. However, scientific evidence for the effectiveness of these programmes is scarce. The present study investigates whether these reimbursement programmes designed to ease the financial and logistical barriers succeeded in increasing the number of living kidney donations at the country level. The study examined within-country variations in the timing of such reimbursement programmes. Method The study applied the difference-in-difference (two-way panel fixed-effect) technique on the Poisson distribution to estimate the effects of these reimbursement programmes on a 17 year long (2000-2016) dataset covering 109 countries where living donor kidney transplants were performed. Results The results indicated that reimbursement programmes have a statistically significant positive effect. Overall, the model predicted that reimbursement programmes increased country-level donation numbers by a factor of 1.12-1.16. Conclusion Reimbursement programmes may be an effective approach to alleviate the kidney shortage worldwide. Further analysis is warranted on the type of reimbursement programmes and the ethical dimension of each type of such programmes.