臨牀透析 Vol.35 No.10(10)


特集名 在宅血液透析の勧め―円滑導入のためのノウハウ
題名 医療経済の面から
発刊年月 2019年 09月
著者 舩越 哲 衆和会長崎腎病院
著者 津久田 健太 衆和会長崎腎病院事務課
【 要旨 】 在宅血液透析(HHD)の普及が遅れている理由の一つに,多くの医療者が「HHDは利益が出ない」というイメージを抱いている可能性が推測されるが,実際は逆で,HHDの利益率は施設透析より高い.HHDの経済効果が理解されない背景には,① 診療報酬(収入)は公示されていても,支出は施設によって異なるため収支の計算が難しい,② 初期投資,つまり透析監視装置・RO装置の購入と患者の初期トレーニングのための人件費の償却の考え方が複雑,という点がある.支出については,施設透析の場合人件費がほぼ半分を占め,これが永続的に発生するのに対し,HHDでは支出に占める人件費率は1~2割であり,この差でHHDの初期投資は2~3年で回収できる計算となる.初期投資回収後の利益率は,HHDにおいて施設透析よりはるかに高く,患者の健康維持のためだけでなく,HHDは収益面においても優れた医療といえる.
Theme Reconsideration of standard hemodialysis: What is the optimal prescription and management for each patient?
Title Profitability of home hemodialysis
Author Satoshi Funakoshi Nagasaki Kidney Hospital
Author Kenta Tsukuda Administrative Work Department, Nagasaki Kidney Hospital
[ Summary ] An important contributor to the low popularity of home hemodialysis (HHD) may be the assumption among health care providers that it is an unprofitable option. However, in reality, the profitability of HHD is higher than that of hospital dialysis. The misunderstanding regarding the economic burden of HHD could be attributed to the following factors: (1) Although the medical fee-for-service is disclosed at the time of initiation of therapy, expenses may differ across hospitals/medical centers because estimating the revenue vs. expenditure is often difficult. (2) Budgeting for home installation of the equipment is a logistically complex activity (i.e., purchasing the dialysis monitoring/reverse osmosis devices and personnel costs for initial patient training). Personnel costs for in-hospital dialysis constitute nearly 50 % of the expenses, which is an ongoing expense. In contrast, personnel costs for HHD constitute 10-20 % of the total costs; thus, the installation costs are recoupable within 2-3 years. Profitability, after recouping the initial costs, is much higher with HHD than with hospital dialysis, indicating that HHD is not only beneficial for maintaining patient health but is also a financially viable option for medical care providers.
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