Current status of health systems financing and oversight for end-stage kidney disease care: a cross-sectional global survey

Abstract

ObjectivesThe Global Kidney Health Atlas (GKHA) is a multinational, cross-sectional survey designed to assess the current capacity for kidney care across all world regions. The 2017 GKHA involved 125 countries and identified significant gaps in oversight, funding and infrastructure to support care for patients with kidney disease, especially in lower-middle-income countries. Here, we report results from the survey for the second iteration of the GKHA conducted in 2018, which included specific questions about health financing and oversight of end-stage kidney disease (ESKD) care worldwide.SettingA cross-sectional global survey.ParticipantsKey stakeholders from 182 countries were invited to participate. Of those, stakeholders from 160 countries participated and were included.Primary outcomesPrimary outcomes included cost of kidney replacement therapy (KRT), funding for dialysis and transplantation, funding for conservative kidney management, extent of universal health coverage, out-of-pocket costs for KRT, within-country variability in ESKD care delivery and oversight systems for ESKD care. Outcomes were determined from a combination of desk research and input from key stakeholders in participating countries.Results160 countries (covering 98% of the world’s population) responded to the survey. Economic factors were identified as the top barrier to optimal ESKD care in 99 countries (64%). Full public funding for KRT was more common than for conservative kidney management (43% vs 28%). Among countries that provided at least some public coverage for KRT, 75% covered all citizens. Within-country variation in ESKD care delivery was reported in 40% of countries. Oversight of ESKD care was present in all high-income countries but was absent in 13% of low-income, 3% of lower-middle-income, and 10% of upper-middle-income countries.ConclusionSignificant gaps and variability exist in the public funding and oversight of ESKD care in many countries, particularly for those in low-income and lower-middle-income countries.

Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives

“…Dialysis is known to be a life-saving renal replacement therapy but it comes with a very high financial burden [ 13 ]. Health systems worldwide carry variable capacities when dealing with the high cost of dialysis [ 20 ]. Both hemodialysis and peritoneal dialysis are modalities that necessitate chronic use of expensive medical supplies and high-cost healthcare services.…”

Epidemiology of haemodialysis outcomes

“…Among the different KRT modalities, in-centre HD incurs the highest cost per patient 212 . According to data available from 97 countries, the average annual cost of maintenance HD (specifically, in-centre HD) was 22,617 international dollars (equivalent to the value of US dollars in 2016) per person per year, but this cost varied widely within countries and by World Bank income group (Supplementary Figure 4 ) 213 . The probability of paying out-of-pocket for HD was inversely related to country income level.…”

“…The probability of paying out-of-pocket for HD was inversely related to country income level. Patients paid 100% of HD treatment costs in 14% of LICs, compared with 11% of LMICs, 7% of UMICs and 4% of HICs 213 . By contrast, patients paid no out-of-pocket costs for HD in 39% of HICs, compared with 20% of UMICs, 17% of LMICs and 23% of LICs.…”

“…By contrast, patients paid no out-of-pocket costs for HD in 39% of HICs, compared with 20% of UMICs, 17% of LMICs and 23% of LICs. In LMICs, where most of the cost burden is shifted from public to private funds, lack of HD can often lead to early death 213 More innovations in the provision of HD care that are cost-effective are needed. A policy shift from in-centre to home-based dialysis will probably lead to less societal cost burden in resource-rich countries 212 .…”

The case for increased peritoneal dialysis utilization in low‐ and lower‐middle‐income countries

“…3,4 A 2015 systematic review showed that about 93% of the global dialysis population lived in high-income and upper-middle-income economies, with the biggest treatment gaps in Asia and Africa. 2 Several factors may account for the wide gaps in utilization of all KRT modalities, especially PD in LLMICs including insufficient funding for healthcare, excessive reliance on out-of-pocket payment systems (OOPPS), 5 absence of adequate infrastructure to support KRT (e.g., steady electricity, clean sources of water supply, etc. ), 6 low availability of workforce 7 and lack of policies for kidney disease management.…”