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D.Nyamsuren: Kidney transplantation fee must be raised

By B.DULGUUN

 The first kidney transplant procedure in 1996 by Mongolian doctors was unsuccessful. After ten years, State Honored Doctor L.Jambaljav and his colleagues from the Mongolian National Central Hospital No.1 successfully conducted a kidney transplant procedure. Currently, State Honored Doctor and Professor of Chronic Kidney Disease Clinic D.Nyamsuren is working as the head of the Kidney Transplant Center team at the National Central Hospital. He has been working with the team since the introduction of kidney transplantation in Mongolia and saved 79 lives. Below is an interview with D.Nyamsuren about kidney transplantation in Mongolia.

-What’s the current actual cost of kidney transplantation?

-The National Central Hospital No.1 conducts kidney transplantation for 12 million MNT. Eight million is paid by the Ministry of Health package and the rest by the patient. At our current price, this budget is not sufficient. The National Central Hospital No.1 is able to transplant kidneys for 10 to 15 each year by cutting costs on other things. We have to make do with what we got. We can’t pay patients expenses with someone else’s payments so kidney transplantation payments must be raised. The current actual expense for kidney transplantation is 27.5 million MNT. Eight million MNT is paid by the Ministry of Health package, four million MNT by the patient and the rest of the expense has been managed by us. After discussing at the board meetings, we made proposals to the Ministry of Health and other places to raise the fee for the transplantation. The ministries promised to discuss and approve the matter in late February. Necessary medication, equipments, materials, immunosuppressant and postoperative treatment expenses are included in the 27.5 million MNT but not fixed costs of rent, doctors’ payment, nurses and caregivers, water and electric bills.

-So how much will the patient pay?

-Of course, we’re thinking of flexible ways for patients to pay. We’re planning to continue to get eight million MNT from the Ministry of Health packages. The remaining 19.5 million MNT will be paid by the patient. However, we’re discussing ways to return 50 to 70 percent back to the patient from the Health Insurance Fund. This applies to every organ transplantation patients, not just kidney transplantation patients. Organ transplantation patients need to be able to pay for their surgery and in return, the government needs to give a certain percentage back to patients from insurance funds. The minimum amount should be 50 to 60 percent of the total cost.  If we change into this system, the health sector will develop. At the current rate, opportunities for the sector to develop through technology and methodologies are very low. The sectors development hasn’t advanced much since the 1970s and 1980s.

-People in western countries pay for every health services they receive including expensive treatments and receive a certain percentage of the payment back from insurance companies. Would it be better if Mongolia’s health system changed to this form?

-Indeed. Medical examination and inspection services in England and Germany are all charged from patients and 60 to 70 percent of their money is paid back through insurance funds regardless of surgery types. We need to follow these western standards.

If we demanded full payment from insurance companies, they will become bankrupt, but we’re not demanding everything, only a certain percentage.

-When the government is planning to make medical treatments, examinations and health services free, can this western standard be met?

-It’s wrong for our authorities to make medical treatments, examinations and health services free of charge instead of cultivating European standards. It is, of course, better for citizens if health services were free but it’s not effective for the sector’s development. In my opinion, certain percentage of health services needs to be paid in order to make technological innovation, improve human resource policies, expand the facilities and provide quality health services.

With our own eyes, we can see that the health sector is circulating in the same place without developing. I’m shocked that they want to make everything free when everyone knows that everything has its own price in a free market society. We can make some differentiations in this. For instance, those who have medium or higher income will pay and get a percentage of it back from insurance funds and those with low standards of living can receive social welfares. Flexible policies are necessary from the Mongolian government, instead of making health services free.

-How much immunosuppressant needs to be consumed by patients? How much money is spent on it from the state budget?

-Approximately 160 to 170 organ transplant patients are consuming immunosuppressant (Prograf, cyclosporine). Around 100 people are taking it for their kidneys and 30 to 40 people for liver. The state is in charge of finances drugs. Immunosuppressants are used a month after surgery. The 1.1 billion MNT financing from the state for drugs in 2013 was barely enough. It wasn’t enough for those who had transplantation abroad. This year’s needs to be at least 2.2 billion MNT. An additional two pills are bought by the patients for extra medication with either Prograf or cyclosporine. This is how it is in world standards. Transplanted organs adapt well if medications are taken regularly, and if immunosuppressant treatment isn’t used, the organs can’t adapt making the surgery useless. This medication is used for the rest of their lives. In other words, they will be under medical control every two, three and six months to get medical instruction to increase or decrease dosage.

-How are kidney disease rates in Mongolia?

-It’s ranked at the third most common disease in Mongolian. From admissions, kidney, urine, and sexually transmitted diseases are ranked in fourth and fifth place. Diseases don’t inform before they come. Where there’s bad lifestyle of malnutrition, alcoholism, smoking, prostitution, sexual disorder and drug abuse, there’s disease.

In recent years, among men, chronic inflammation of prostate, harmful and harmless cancers have been diagnosed, as well as urinary tract infection diseases caused by all kinds of sexually transmitted diseases. Glumerulo inflammation of kidney has also increased. This is mainly connected to leaving tooth decays, leak of ear scrofula and festering untreated for a long period of time. If both kidneys are heavily infected, it has to be transplanted or an artificial kidney device has to be implanted. Approximately 99 percent of today’s transplant patients have glumerulo inflammation in the kidney and only one to two percent with renal vascular congestion, diabetes or congenital anomaly.

-As of now, how many people are in need of kidney transplantation?

-Around 300 people are getting treatment for artificial kidney devices. These people need kidney transplantation. There are also a number of people unable to get artificial kidney devices. They also need the transplantation.

-In the Law on Donation, it’s specified to use donations from the deceased. Is this possible for our country? Are there any resources?

-The Law on Donation was first approved in January 22, 2000 and revised in May 22, 2012. There are many people who are willing to donate their organs for their families in Mongolia. However, almost everyone was infected with “Shpritsnii Shar” in the 1970s, 1980s and 1990s and most people now have Liver B or C viruses which aren’t good for donations. Not everyone can become donors. In the law, it’s stated that it’s best to get donations from the deceased. However, in Mongolia, we can’t even get a single organ because some believe that ghosts of the deceased will wander. When we asked monks about the matter, they said it wasn’t true and that it’s the highest generosity of one.

Family members of four deceased donated kidneys and saved eight lives.

-Is it true that younger people are getting kidney diseases? Is it possible for children to get kidney transplantation from adults?

-I don’t agree that younger people are having more kidney diseases. In recent years, diagnosis and treatments have improved. With developed statistics, accounting and infrastructure, we’re able to diagnose and treat diseases quickly.

They could get diseases from external factors such as air and soil pollution or food.

In Mongolia, the first kidney transplantation for a child was conducted in 2006. Kidney from the father was transplanted to the child. We’re now preparing to transplant kidney to a child. The competency of Mongolian kidney transplanting team has increased over the years. Especially in the last three to four years. You can trust our Mongolian team’s ability.

From late February to early March, three operations are planned. We will gather publishable information from our 80th kidney transplant patient to send good message to fellow Mongolians.

-There aren’t any doctors for kidney surgeries in provinces which increases the workload of the kidney department of the National Central Hospital No.1. How will this be managed in the future?

-It’s been decided that in 2014, 21 provinces and district hospitals will each have doctors for kidney surgeries and 17 provinces to get diagnostic and therapeutic endoscopy. The Minister of Health will give her orders soon. Kidney Surgery Department and my team will get a four to six month of training to prepare kidney surgeons and will start working in provinces. If 40 to 60 percent of patients are treated in provinces, the National Central Hospital No.1 will have time to conduct studies and research.

 

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Posted by on Feb 27 2014. Filed under Топ мэдээ. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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