The effect of outpatient dialysis global budget cap on healthcare utilization by end-stage renal disease patients

► Dialysis providers reimbursed under a narrow band global budget seemed to both unbundle services and increase self-interest referrals. ► To mitigate financial risk of payment reforms, cost reduction and revenue enhancement are strategies adopted by providers. ► A narrow band global budget may constrain costs for some illness but may also cause downstream inefficiencies for others.