Table 3 effects of the retrospective payment systems for dialysis services based on the studies

1

Under treatment

Avoiding to provide unpaid and inexpensive services

discourage “intellectual services” e.g. preventive strategies, consultations, counseling (Belgium, FFS ^b) [17]^a,

Reduce services with no payment coverage (e.g. paramedical care like psychological care) (Belgium, FFS) [17]^a

discourage the use of home-based therapies (Belgium, FFS [17]^a; USA, 2004 reform) [30]

late referral to the nephrology unit (Belgium, FFS) [17]^a

Replacing more expensive modalities with less expensive ones e.g. home-based therapies (Belgium, FFS) [17]^a

2

over treatment and increasing cost

A shift to provide services which are better paid

technical services are heavily overpaid (Belgium, FFS) [17]^a

providing unnecessary services where a referral could be a better choice (Belgium, FFS) [17]^a

Number of visits and Medicare costs increased in tiered FFS (USA, 2004 reform) [9, 16]