The Role of Public-Private Partnerships in Providing Renal Replacement Therapy to Patients With Chronic Kidney Disease

Hightlights The theoretical novelty of this study lies in expanding of current knowledge regarding the impact of public-private partnerships on the organization of outpatient renal replacement therapy for patients with chronic kidney disease within the compulsory health insurance system. Aim . To identify the main challenges in organizing renal replacement therapy in outpatient settings, including through the implementation of public-private partnerships in the compulsory health insurance system. Methods . The volumes of outpatient dialysis services in the nephrology specialty and their funding for the period 2016–2025 were assessed using data from the information system of the Tomsk Region Territorial Compulsory Health Insurance Fund. Planned and actual indicators for medical organizations were obtained by multiplying the dialysis service tariff by the approved volumes of services provided, as specified in the first and last decisions of the Commission for the Development of the Territorial Compulsory Health Insurance Program for each year of the study period. The volumes of medical services actually provided by Nephroline-Tomsk LLC and their funding were obtained from medical invoice registers. Results . Significant changes in the provision of outpatient renal replacement therapy in the Tomsk Region were identified during the study period. First, the number and organizational and legal structure of medical organizations providing these medical services have changed. Until 2016, dialysis services were provided by two state medical organizations; by 2025, the number of organizations increased to six, four of which were private. With an increase in the total volume of dialysis services by 1.5 times (2016 – 42,192 services, 2025 – 63,516 services), a decrease in outpatient renal replacement therapy in state medical organizations by 74% was revealed (a total of 18,307 and 4,726 services in 2016 and 2025, respectively). Funding for outpatient dialysis services for 2016–2025 increased by 2.2 times (204.17 and 456.84 million rubles in 2016 and 2025, respectively). This is due to an increase and redistribution of funding toward private medical organizations (2016 – 115.76 million rubles; 2025 – 420.85 million rubles). Volumes were distributed unevenly among private organizations, with Nephroline-Tomsk LLC usually having the highest number of dialysis cases. This organization has the longest and most continuous history of providing renal replacement therapy in the region, providing these services not only in the regional center but also in three districts, thereby increasing access to medical care. Conclusion . An increase in the share of outpatient renal replacement therapy volumes and funding for private medical organizations has been noted, while public (regional and federal) organizations focus on inpatient dialysis services. The issue of providing dialysis services can be resolved through broader integration of public-private partnerships into the healthcare system. Harmonization of terminology will improve the accuracy of planned volumes and funding for medical services.