Table 3.

effects of the retrospective payment systems for dialysis services based on the studies

	effects	description	Examples from the studies
1	Under treatment	Avoiding to provide unpaid and inexpensive services	discourage “intellectual services” e.g. preventive strategies, consultations, counseling (Belgium, FFS b) [17]a, Reduce services with no payment coverage (e.g. paramedical care like psychological care) (Belgium, FFS) [17]a discourage the use of home-based therapies (Belgium, FFS [17]a; USA, 2004 reform) [30] late referral to the nephrology unit (Belgium, FFS) [17]a Replacing more expensive modalities with less expensive ones e.g. home-based therapies (Belgium, FFS) [17]a
2	over treatment and increasing cost	A shift to provide services which are better paid	technical services are heavily overpaid (Belgium, FFS) [17]a providing unnecessary services where a referral could be a better choice (Belgium, FFS) [17]a Number of visits and Medicare costs increased in tiered FFS (USA, 2004 reform) [9, 16]

^a Unproven claimed effect

^bFee for service