Effect of patient solicitation on mortality among patients receiving hemodialysis in Korea

Abstract

Background: There is concern that overcompetition and illegal activities such as patient solicitation by some dialysis units may threaten patients’ health in Korea. Therefore, we investigated the effect of nephrologists’ patient-soliciting activity on hemodialysis practices and patients’ survival using the Korean Health Insurance Review and Assessment Service database. Methods: We selected 19 soliciting hemodialysis facilities and matched them with 19 non-soliciting facilities located nearby to eliminate location bias. Soliciting behavior was defined as the reduction of medical fees or providing money to attract dialysis patients. Results: A total of 2,231 incident dialysis patients were included and followed for a median of 37.2 months. Soliciting facilities had a lower percentage of nephrologists, a higher average daily number of hemodialysis patients per physician, and a higher number of hemodialysis patients per nurse compared with non-soliciting facilities. Survival analysis showed that the crude mortality was significantly higher in patients treated in soliciting facilities than in those treated in non-soliciting facilities, even after adjustment for the effects of many other independently predictive covariates. Conclusions: This study demonstrated that in Korea, the overall mortality rate in incident dialysis patients was higher in those attending soliciting facilities than in those attending non-soliciting facilities.