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. 2020 Aug;5(8):e002596.
doi: 10.1136/bmjgh-2020-002596.

The impact of country reimbursement programmes on living kidney donations

Abu Bakkar Siddique  1 , Vandana Apte  2 , Sigrid Fry-Revere  3 , Yanhong Jin  2 , Naoru Koizumi  4
Affiliations

The impact of country reimbursement programmes on living kidney donations

Abu Bakkar Siddique et al. BMJ Glob Health. 2020 Aug.

Abstract

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.

Keywords: health economics; health policy; other study design.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Evolution of country reimbursement programme: (2000–2016).
Figure 2
Figure 2
Donations per million by country in 2015. Note: authors’ recreation of the map based on the data from Global Observatory on Donation and Transplantation and International Registry on Organ Donation and Transplantation.
Figure 3
Figure 3
Coefficient plots. The coefficient plots were created using estimates of model 4 in table 2.
See this image and copyright information in PMC

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