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HomeMy WebLinkAboutFCS-11-132 - Feasibility of Establishing a Financial AssistanceREPORT TO:Finance and Corporate Services Committee DATE OF MEETING: June 20, 2011 SUBMITTED BY: Joyce Evans, Director of Revenue , 519-741-2895 PREPARED BY: John Sonser, Revenue Analyst, 519-741-2954 WARD(S) INVOLVED: All DATE OF REPORT: June 14, 2011 REPORT NO.: FCS-11-132 SUBJECT: Feasibility of Establishing a Financial Assistance Program for Home Dialysis RECOMMENDATION: WHEREAS kidney dialysis is a provincial health-care responsibility; and, WHEREAS the Province has established an objective to have at least 35% of dialysis patients treated at home by 2013; and, WHEREAS home dialysis is a less expensive treatment than dialysis in the hospital; and, WHEREAS home dialysis imposes increased hydro, water, sewer utility costs on the patients’ household; THEREFORE BE IT RESOLVED that the City of Kitchener request that the Ministry of Health fund the incremental utility costs as a direct expense for patients receiving home dialysis. BE IT FINALLY RESOLVED that this resolution be shared with the Regional Municipality of Waterloo which provides water treatment and waste-water treatment services, local municipalities within the Region, the 4 local MP’s and the Association of Municipalities of Ontario. BACKGROUND: On April 18, 2011 Council directed Staff to report to the Finance and Corporate Services Committee on the feasibility and implications of establishing a program to provide financial assistance in respect of water/sewer utility costs for those patients utilizing home dialysis. This report has been prepared in response to that direction. REPORT: Background Information on Kidney Dialysis A report released by the Canadian Institute for Health Information on January 20, 2011 shows that at the end of 2009, 37,744 people were being treated for end-stage renal disease of which 59 percent were on dialysis. ì ó ï Dialysis treatment comes in two forms: Peritoneal dialysis (PD) - a process where the blood is cleaned by placing dialysis fluid in the peritoneal cavity and changing the fluid throughout the day, and Hemodialysis dialysis (HD) – a process where blood is withdrawn from the body by a machine and passed through an artificial kidney called a dialyzer. According to the Ministry of Health and Long-Term Care, nearly 10,000 Ontarians receive dialysis treatment; and of these, over 2,400 patients receive home dialysis. Ontario is aiming to have at least 35 per cent of dialysis patients treated at home by 2013. There are approximately 2,000 patients at the Grand River Hospital renal clinic here in Kitchener and another 1,000 at the Guelph satellite location. Of these, 460 patients are on dialysis. Grand River Hospital’s home dialysis program benefits 130 area patients (22 HD patients and 108 PD patients). This represents an increase of over 50% since 2008. Currently, there are 22 patients on home hemodialysis of which 10 patients are in Kitchener-Waterloo area. Types of Dialysis and Associated Costs Hemodialysis (HD) requires a patient to be hooked up to a machine that performs the function of the kidneys by filtering toxins out of the bloodstream. The reverse osmosis machines, needed for dialysis treatments, can use as much as 348 litres of water each hour. In-hospital (or in-centre) HD treatments typically run three days per week, often for four hours per session. The cost of in-hospital dialysis can range from $69,000 to $75,000 per year. The costs include nursing and hospital overhead. Home HD comes in three forms: 1. Conventional HD (three days per week at four hours per day) 2. Nocturnal HD (six days per week at eight hours per day) 3. Daily HD (six days per week at two and a half hours per day) Home HD programs are funded by the Provincial government through the Ontario Renal Network (a division of Cancer Care Ontario). This includes initial up-front cost related to equipment, installation (plumbing and electrical), training, etc. The cost of Home HD for the first year would be approximately $35,000. Also covered by the program are ongoing maintenance costs (including supplies and solutions) that range from $18,000 for Conventional HD treatment to $35,000 for Nocturnal HD or Daily HD treatment. The benefits of home dialysis are significant to patients, boosting independence and health. It also costs the Province less when compared to in-hospital (IH) treatment, anywhere from $10,000 to $25,000 less per patient. There are added costs of water and power consumption in the home that are not covered by the Renal Dialysis Program and results in an out-of-pocked expense for the home-dialysis patient. Water consumption per hour varies depending on the treatment method and equipment used. Table 1 is a summary of hemodialysis treatments available to home dialysis patients, including treatment, cleaning times and water consumption for each: ì ó î Table 1: öر³»Ü·¿´§­·­É¿¬»®Ý±²­«³°¬·±² Ю»°¿®¿¬·±² Ì®»¿¬³»²¬Ì·³»É¿¬»®½±²­«³°¬·±² ¿²¼Ü·­·²º»½¬·±² Ó±¼¿´·¬§Ì§°»øý±ºØ±«®­°»®Ô·¬®»­°»®¸±«®ø¾§ Ì·³»°»® ­»­­·±²÷»¯«·°³»²¬÷ ­»­­·±² ¢ô£k?¡¢âÃ??¡ Ø»³±¼·¿´§­·­øØÜ÷æøر«®­÷ ݱ²ª»²¬·±²¿´ØÜ 3ô£k?024, Ò±½¬«®²¿´ØÜ 3ô£k?,3+/ Ü¿·´§ØÜ 3ô£k?2È/222 * Provided by Peter Varga, Program Director Renal Dialysis, Grand River Hospital The additional cost to a City of Kitchener customer on Home HD can range from $535.54 to $1,807.44 per year for water and sewer, depending on the modality type: Table 2 provides a summary of the costs, using the data provided by Grand River Hospital and the City’s current water and sewer rates (Water $1.5714; Sewer $1.7295). Table 2 ر³»Ü·¿´§­·­É¿¬»®Ý±²­«³°¬·±²Ý±­¬ Ì®»¿¬³»²¬Ì·³»É¿¬»®ß²²«¿´É¿¬»®ú ø·²½´«¼·²¹Ì®»¿¬³»²¬­Ý±²­«³°¬·±²°»®Í»©»®Ý±­¬­øÝ·¬§ Ó±¼¿´·¬§Ì§°» °®»°¿®¿¬·±²¿²¼°»®É»»µÇ»¿®ø¾§±ºÕ·¬½¸»²»® ½´»¿²·²¹÷»¯«·°³»²¬÷Ý«®®»²¬Î¿¬»­÷ Ø»³±¼·¿´§­·­ Ûk«?«1x øØÜ÷æøر«®­÷ ݱ²ª»²¬·±²¿´/13.2È20x/1/È/0 Ò±½¬«®²¿´+./0-È/.x3Ë,4-È00 Ü¿·´§1È/.202È020x,44È22 While the direct cost of utilities is not covered by the hospital renal program, the Kidney Foundation of Canada lists a number of tax tips on their website for kidney patients. Included in the tax tips is the allowance by the CRA for kidney patients to deduct utility expenses as an allowable medical expense for the “Medical Expense Tax Credit.” ì ó í Research on Financial Assistance Programs for Home Dialysis The only known municipality in Ontario that has a grant program in place for customers on home dialysis is the City of Ottawa. Ottawa Council’s motion 11/10 on April 11, 2007, directed staff to develop a Home Dialysis Grant Program to assist homeowners with the incremental costs of water consumption associated with the operation of home dialysis equipment. The funding for the grant comes from the City-Wide Reserve Fund and is in cooperation with the Medical Officer of Health. The grant funding received a budget of $10,000 in 2007 and allows for a grant of up to $500 annually depending on the consumption. The program is authorized by Section 107 of the Municipal Act, 2001, S.O. 2001, c.25, as amended. Amongst the issues that need to be considered is whether the local governments should be infringing on matters involving Provincial health-care jurisdiction. In addition, the cost/benefit of implementing a grant program would need to be determined. Potential costs associated with setting up a Grant program for home dialysis would include initial program set up involving I.T. programming costs, documenting procedures, forms, processing applications, and distributing the grants. Recommendation Staff do not recommend providing a financial assistance program for the water and sewer costs associated with home dialysis for the following reasons: Health care falls under provincial jurisdiction and costs associated with home dialysis are a provincial matter. The Region provides water treatment and waste-water treatment services and yet the cost of a financial assistance program might be borne fully by the City of Kitchener Utility costs are deductable as a medical expense for income tax purposes. Other tax tips for dialysis patients are listed on The Kidney Foundation of Canada’s website. The Province is saving money on home HD cases when compared to traditional hospital-based treatment, which suggests that there is capacity in the system to fund the additional utility costs. With the exception of City of Ottawa (which has the responsibility to deliver public health services) local governments do not appear to support offering grants to assist customers who incur extra water and sewer expenses for medical treatments. Providing financial assistance could set precedent for other medical or like-minded programs. Financial assistance would likely need to come by way of a grant from the tax-base (as opposed to the water/sewer budgets) given the need to maintain a nexus between the user fee charged for a service and the consumption of that service by the user. In light of these considerations, staff recommends that the City of Kitchener request that the Ministry of Health fund the incremental utility costs as a direct expense for patients receiving home dialysis. ì ó ì ALIGNMENT WITH CITY OF KITCHENER STRATEGIC PLAN: Foundation: Effective and Efficient Government Goal: Financial Management Strategic Direction: Ensure responsible stewardship of public funds within a supportive policy framework. FINANCIAL IMPLICATIONS: The cost of a full financial assistance program for incremental water and sewer costs, at the current Home HD patient level, could range from $5,000 to $18,000 and potentially reach $7,000 to $26,000 if the 35% provincial target is met by 2013. This is based on the current local caseload and could increase beyond these levels should the caseload increase. Additional costs would be incurred with the implementation and administration of the program and have not yet been defined in detail. COMMUNITY ENGAGEMENT: Staff obtained information from the Grand River Hospital when compiling data for this report. ACKNOWLEDGED BY: Dan Chapman, Deputy CAO, Finance and Corporate Services ì ó ë