Our first Commission Reportpublished in this issue of Nature Medicineoriginates from Thailand. Since introducing its Universal Health Coverage (UHC) scheme in 2001, Thailand has increased access to essential health services and reduced health-related out-of-pocket spending for its inhabitants, performing well on UHC-related SDG indicators. It is also one of the minority of low- and middle-income countries (LMICs) that have integrated dialysis policy into their UHC program.
Since 2008, Thailand has operated a policy whereby most patients are covered for home-based peritoneal dialysis (PD), and only those medically ineligible for PD are offered free clinic-based hemodialysis (HD), which is more costly. Despite some criticism for limiting patient choice, the ‘PD-first’ approach was held up as an example of sustainable dialysis policymaking. But in 2022, an abrupt change to allow patients to choose either dialysis modality led to serious unintended consequences. The number of new patients receiving HD increased far beyond expectations, as did costs and mortality rates in patients initiating HD.
The purpose of the current commission — comprising Thai and international experts — was to resolve the ongoing dialysis policy challenges in Thailand and offer lessons for other countries working to expand access to dialysis within UHC frameworks.
