Fig. 1: Constrained resources necessitate careful balancing of financial sustainability, quality of care and ethical considerations.

a, The initial estimate of new patients initiating HD was approximately 6,000 patients (red node (middle left), representing those previously paying out of pocket (OOP) for HD); however, following the 2022 policy change, the number of new patients initiating dialysis reached 56,000, 86% of whom received HD (top left). KT, kidney transplant. b, If the proportion of new patients undergoing HD shown in a persists, the projected cost of the 2022 dialysis policy could reach about 30% of the UHC budget while serving less than 1% of its beneficiaries. Dialysis costs were projected on the basis of the costs of PD and HD multiplied by the number of new patients initiating dialysis (modeled using Markov); the UHC budget is the total budget within the UHC scheme (which includes the budget for other diseases), and was projected using regression. WTP, willingness to pay.