EVIDENCE BASEDÌýINSIGHT
Fresenius Kidney Care in Asia Pacific
September 21, 2020 Ä¢¹½´«Ã½¢ 5 min read
ÌýÄ¢¹½´«Ã½¢Ìý
Healthcare systems within the Asia Pacific region are all very different in terms of size, maturity, reimbursement structures, and progress toward integrated care.ÌýÄ¢¹½´«Ã½ is addressing these complex disparities in a variety of ways. Initiatives include programs to identify gaps in systems and kidney care services, ensure dialysis delivery in developing markets, and promote medical education and professional development throughout the region.
GENERAL OVERVIEW IN THE ASIA PACIFIC REGION
The disease burden of chronic kidney disease (CKD) and endstage kidney disease (ESKD) in Asia Pacific is generally highÌýdue to many factors, ranging from a lack of access to healthcareÌýin developing countries to an increase in lifestyle-relatedÌýdiseases in developed economies. It is important to refrain fromÌýviewing Asia Pacific as a homogenous region and to understandÌýthe fundamental differences between developing and matureÌýhealthcare systems. This is true across the region, but it is oftenÌýalso trueÌý·É¾±³Ù³ó¾±²ÔÌýcountries.
In some Asia Pacific countries, uneven economic developmentÌýresults in a highly fragmented healthcare landscape withÌýsignificant discrepancies between the under-resourced publicÌýsector and a high-end private sector that featuresÌý tate-of-the-artÌýmedicine at high prices. In countries such as China, India, andÌýIndonesia, it is necessary to provide treatment service bundlesÌýbased on available resources and a comprehensive healthcareÌýframework provided by the government.
The typical dialysis facility in Asia Pacific is often located in standaloneÌýcenters; however, the physical setup differs from market toÌýmarket. Some centers deliver dialysis services in public hospitals,Ìýsuch as China. Most dialysis treatments in Singapore are providedÌýat charitable organizations, while physician-operated privateÌýcenters provide the majority of dialysis in Korea.
FRESENIUS KIDNEY CARE NETWORK IN ASIA PACIFIC
As of Q4 2019,ÌýÌýprovided over three million dialysis treatments at nearly 300Ìýclinics across 10 markets (Figure 1). Based on the payor andÌýhealthcare systems, the developing markets include China, India,ÌýIndonesia, Malaysia, Philippines, and Thailand. The matureÌýmarkets include Australia, Hong Kong, Singapore, and Taiwan.
REIMBURSEMENT STRUCTURES
Financing mechanisms within Asia Pacific are diverse, mirroringÌýthe marketÄ¢¹½´«Ã½™s economic development. Reimbursement structureÌýranges from mature universal health coverage (Australia andÌýTaiwan) to developing universal healthcare coverage (IndonesiaÌýand Malaysia). Some markets (Singapore) lie in the middle, withÌýsystems such as medical savings accounts. Other markets operateÌýmostly private, out-of-pocket payment systems (India and Pakistan).
For dialysis treatments, reimbursement rates in some marketsÌý(Australia) cover only treatment and core consumables, whileÌýother markets (Taiwan) cover a fulsome collection of related careÌýcomponents like transportation, lab services, diagnostics, Heparin,Ìýand other medication.
Funding limitations (as evidenced in the Philippines) often lead toÌýmissed treatments and potentially suboptimal outcomes (Figure 2).
Ìý
FIGURE 2Ìý| Financing mechanism with the triangular funnel representing the amount of reimbursements from national insurance structures
FKC-AP CLINICS
Providing dialysis services in developing markets comes withÌýmany challenges, such as a lack of reliable water sources,Ìýelectricity, and internet connectivity. To mitigate theseÌýchallenges, Ä¢¹½´«Ã½ employs the use of waterÌýtanks, generators, and manual processes. When resources andÌýfinances are scarce, dialyzer reuse is common. Furthermore, inÌýmany markets, there are simply not enough medical professionalsÌýto care for the CKD and ESKD populations. For example, as ofÌýQ1 2020, in India there are only around 1,350 nephrologists forÌýa population of 1.3 billion compared with Taiwan, which hasÌýapproximately 1,500 nephrologists for a population of 24 million.Ìý
Clinical care decisions also vary between the markets in the AsiaÌýPacific region served by Ä¢¹½´«Ã½. For example,Ìýconsider a common clinical goal, such as anaemia management.ÌýFor developing markets, the most important goal may beÌýestablishing regular hemoglobin testing and providing adequateÌýinformation regarding medications. However, in economicallyÌýestablished markets, the focus may be on introducing newÌýpharmacological agents like hypoxia-inducible factor prolylÌýhydroxylase inhibitors (HIF-PH) inhibitors, which may representÌýclinical advancements in treatment but are costly.
COLLABORATIVE PARTNERSHIPS
Local medical specialty associations, like a countryÄ¢¹½´«Ã½™s nephrologyÌýsociety, are influential and drive clinical practise via guidelinesÌýand best practise advice for members. Such recommendations mayÌýdiffer slightly from international uidelines due to local needs,Ìýthe constraints of the marketsÄ¢¹½´«Ã½™ healthcare system, and patientÌýcharacteristics; therefore, a harmonisation of clinical processesÌýand medical practise can be challenging.
Being able to offer a continuum of care across the entire diseaseÌýspectrum for individuals living with CKD is ideal for improvingÌýpatient outcomes. Due to the various constraints in the regionalÌýhealthcare systems, opportunities for FKC-AP are currentlyÌýlimited; however, new approaches to care are being explored.
The company is collaborating with governments and otherÌýstakeholders to establish disease management processes ·É¾±³Ù³ó¾±²ÔÌýthe given legal and economic frameworks of the market.
Medical education is crucial for the efficiency of a healthcareÌýsystem. Because FKC-AP is highly dependent on a skilledÌýworkforce, the company has established continuous medicalÌýeducation for physicians, nurses, and other healthcareÌýprofessionals as a core pillar of service operations. The FreseniusÌýMedical Care Asia Pacific Education Center, created in 2019,Ìýsupports the professional development and education of FKCAPÌýstaff and dialysis nurses from the public sector. TwentyÌýprograms are offered, ranging from an introduction to dialysis toÌýpreceptorship and mentoring. This center of excellence is key toÌýensuring the FKC-AP staff is educated, motivated, and competentÌýto provide the best possible care for patients.
DELIVERING QUALITY CARE
FKC-AP has implemented several quality systems, including anÌýinfection prevention and control link nurse program, incidentÌýand risk management system, directive establishment andÌýreview process, and quality improvement and risk registers, asÌýwell as consumer feedback management. The WeAudit programÌýwas implemented to identify gaps in systems and services,Ìýmeasure improvements, identify opportunities to furtherÌýimprove safety, and develop quality improvement initiatives.ÌýTo further strengthen care delivery, FKC-AP has partnered withÌýthe Australian Council on Healthcare Standards InternationalÌýto pursue external accreditation in six markets. Despite theÌýdifferent levels of healthcare delivery maturity, these markets haveÌýsuccessfully attained international accreditation, which not onlyÌýestablishes public, staff, and patient confidence but also drivesÌýcontinuous leadership, patient care, and education leadership.
DEVELOPING CARE LANDSCAPE
An integrated approach to care, encompassing early interventionÌýand comprehensive disease management, is one of the mostÌýpromising opportunities to slow CKD progression and improveÌýcare outcomes in this population. However, this model requiresÌýa healthcare system framework to regulate patient flow,Ìýmanagement quality control, and reimbursement for medicalÌýservices. Healthcare systems in the Asia Pacific region varyÌýconsiderably in terms of readiness to embark on such activities.
Some markets in the region have already begun exploring theÌýidea of integrated care, and FKC-AP is actively involved inÌýdialogue with government authorities regarding piloting newÌýconcepts. In China, where the companyÄ¢¹½´«Ã½™s footprint is primarilyÌýmidsize hospitals in suburban settings, plans exist to convert suchÌýfacilities into renal specialty hospitalsÄ¢¹½´«Ã½”catering to the needs ofÌýCKD and ESKD patients and enabling a continuum of care forÌýthis population in one facility. Comparatively, in other Asia PacificÌýmarkets, FKC-AP may be focused on providing basic dialysis careÌýuntil public health systems are more established.
An experienced global partner, Ä¢¹½´«Ã½ isÌýsupporting the Asia Pacific region as the need for timely andÌýtailored CKD and ESKD healthcare evolves. The landscape ofÌýhealthcare systems across the region requires cost-effective,Ìýinnovative solutions. By engaging with policy makers and medicalÌýprofessionals in each market, the company is working to improveÌýpatient care.
