The "PD First" policy in Thailand: three-years experiences (2008-2011).

Universal coverage (UC) scheme is a reformed national healthcare insurance that has been set up since the year 2002 and covers more than 80% of Thai population who are self-employed and do not work as government employees. Initially, this scheme offered only basic and comprehensive healthcare while renal replacement therapy (RRT), the financial cost of which was high, was not included. Without the support from the government healthcare insurance, the patients and their families will become insolvency. The benefit of peritoneal dialysis (PD) over hemodialysis (HD) has been shown in terms of medical expenses and cost-effectiveness. The "PD First" policy in Thailand has been implemented on January 1st 2008 as a model of initial treatment of end stage renal disease (ESRD) patients under the UC scheme. During the year 2008-2011, 12,753 cases, 6,177 were male and 6,576 were female, registered in this modality. The technical survivals at 1, 2 and 3 years were 92, 85 and 80%, respectively while the patient survivals were 79, 66 and 57% at 1, 2 and 3 years, respectively. The hematocrit level had been significantly increased from 25.9 +/- 5% in October 2009 to 28.0 +/- 5% in October 2010. The Peritonitis rate was decreased from 20.7 per patient months during the year 2009 to 25.8 per patient months at the year 2011 and the exit-site infection rate was 1 episode per 40.7 patient months. Currently, there are 111 PD centers that service for ESRD patients nationwide. There are strong supports from The National Health Security Office, The Nephrology Society of Thailand, The Dialysis Nurse Association, The Kidney Foundation of Thailand The Ministry of Public Health, The Thai Kidney Patient Association, Chulalongkorn University, Thai Red Cross Society, community, and social network, all of which are the major factors to guarantee the salutary outcomes in the future.