Health Policy for Dialysis Care in Canada and the United States

被引:8
|
作者
Tonelli, Marcello [1 ]
Vanholder, Raymond [2 ,3 ]
Himmelfarb, Jonathan [4 ,5 ]
机构
[1] Univ Calgary, Div Nephrol, Dept Med, Calgary, AB, Canada
[2] Ghent Univ Hosp, Nephrol Sect, Dept Internal Med, Ghent, Belgium
[3] European Kidney Hlth Alliance, Brussels, Belgium
[4] Kidney Res Inst, Sch Med, Seattle, WA USA
[5] Univ Washington, Div Nephrol, Dept Med, 908 Jefferson St, Seattle, WA 98104 USA
基金
加拿大健康研究院; 加拿大创新基金会;
关键词
dialysis; health policy; innovation; transnational comparisons; Kidney Failure; Chronic; peritoneal dialysis; Renal Insufficiency; Health Care Costs; Government; RENAL REPLACEMENT THERAPY; STAGE KIDNEY-DISEASE; FOR-PROFIT; FACILITY OWNERSHIP; HEMODIALYSIS; OUTCOMES; ACCESS; REIMBURSEMENT; MANAGEMENT; QUALITY;
D O I
10.2215/CJN.14961219
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Contemporary dialysis treatment for chronic kidney failure is complex, is associated with poor clinical outcomes, and leads to high health costs, all of which pose substantial policy challenges. Despite similar policy goals and universal access for their kidney failure programs, the United States and Canada have taken very different approaches to dealing with these challenges. While US dialysis care is primarily government funded and delivered predominantly by private for-profit providers, Canadian dialysis care is also government funded but delivered almost exclusively in public facilities. Differences also exist for regulatory mechanisms and the policy incentives that may influence the behavior of providers and facilities. These differences in health policy are associated with significant variation in clinical outcomes: mortality among patients on dialysis is consistently lower in Canada than in the United States, although the gap has narrowed in recent years. The observed heterogeneity in policy and outcomes offers important potential opportunities for each health system to learn from the other. This article compares and contrasts transnational dialysis-related health policies, focusing on key levers including payment, finance, regulation, and organization. We also describe how policy levers can incentivize favorable practice patterns to support high-quality/high-value, person-centered care and to catalyze the emergence of transformative technologies for alternative kidney replacement strategies.
引用
收藏
页码:1669 / 1677
页数:9
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