Health Policy for Dialysis Care in Canada and the United States.

Publisher: Wolters Kluwer Health Country of Publication: United States NLM ID: 101271570 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1555-905X (Electronic) Linking ISSN: 15559041 NLM ISO Abbreviation: Clin J Am Soc Nephrol Subsets: MEDLINE

Publication: 2023- : Hagerstown, MD : Wolters Kluwer Health
Original Publication: Washington, D.C. : American Society of Nephrology, c2005-

Health Policy* ; Renal Dialysis*/economics ; Renal Dialysis*/standards; Ambulatory Care Facilities/*organization & administration ; Kidney Failure, Chronic/*therapy; Aged ; Ambulatory Care Facilities/economics ; Ambulatory Care Facilities/legislation & jurisprudence ; Canada ; Female ; Financing, Government ; Humans ; Male ; Medicaid/economics ; Medicare/economics ; Middle Aged ; Survival Rate ; Treatment Outcome ; United States

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.
(Copyright © 2020 by the American Society of Nephrology.)

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Canada CIHR

Keywords: Chronic; Government; Health Care Costs; Kidney Failure; Renal Insufficiency; dialysis; health policy; innovation; peritoneal dialysis; transnational comparisons

Date Created: 20200627 Date Completed: 20211122 Latest Revision: 20230421

20230422

PMC7646249

10.2215/CJN.14961219

32586926