Capacity of Kidney Care in Canada: Identifying Barriers and Opportunities

Abstract

Background: Chronic kidney disease (CKD) is a significant health problem in Canada. Understanding the capacity of the Canadian health-care system to deliver kidney care is important to provide optimal care. Objective: To compare Canada’s position in relation to countries of similar economic standing. Design: Cross-sectional electronic survey. Setting: Member countries of the Organisation for Economic Co-operation and Development (OECD) that participated in the survey. Participants: Nephrologists, other physicians, policymakers, and other professionals with relevant expertise in kidney care. Measurements: Not applicable. Methods: A survey administered by the International Society of Nephrology assessed the global capacity of kidney care delivery. Data from participating OECD countries were analyzed using descriptive statistics to compare Canada’s position. Results: Of the participating countries, most funded kidney care services (non-medication) by government (transplantation: 85%, dialysis: 81%, acute kidney injury (AKI): 77%). Most countries covered medication. Canada reported a public funding model for kidney services and a mix of public and private sources for medication. Nephrologists and nephrology trainee densities were lower in Canada compared to the median (15.33 vs. 25.82 and 1.74 vs. 3.94, respectively). CKD was recognized as a health priority in five countries, but not in Canada. Registries for CKD did not exist in most (24/26) countries. Canada followed a national strategy for noncommunicable diseases, but this was not specific to CKD care, dialysis, or transplantation. Limitations: Risks of recall bias or social desirability bias are present. Differences in a number of factors could influence discrepancies among countries and were not explored. Responses reflected the existence of practices, policies, and strategies, and may not necessarily describe action or impact. Capacity of care is not equal across all regions and provinces within Canada; however, the findings are reported on a national level and therefore may not appropriately address variability. Conclusions: This study describes the capacity for kidney care at a national level within the context of the Canadian health system. The Canadian health-care system is well funded by the government; however, there are areas that could be improved to increase the optimization of kidney care provided.

International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in North America and the Caribbean

“…30 This could be due to differences in GDP, percentage of GDP spent on health care, and/or differences in dialysis delivery systems. [31][32][33] For instance, in Canada, long-term dialysis therapy is almost entirely provided by not-for-profit, government-funded facilities, because the country does not have private or for-profit dialysis providers. 32 However, in the United States, although the costs of KF care are primarily covered by the government (80%), reimbursement for dialysis occurs via parallel systems of public and private funding (i.e., Medicare/Medicaid and private insurers, depending on the patient's employment status).…”

Hospital Costing Methods: Four Decades of Literature Review

“…There is no consensus on the best format for such controls. The literature indicates that the greater the complexity or size of the hospital, the greater the tendency to use more in-depth financial analysis or more accurate costing methods, such as the ABC method (Thomson et al 2019) and cost and effectiveness analysis (Lunney et al 2019). It is important to note that cost systems are commonly confused with costing methods, but the difference is that cost systems accumulate cost information and costing methods calculate the cost of products or services, which characterize the types (for example, the cost of a particular surgery, the cost of a daily hospital stay, performance analysis of a sector such as the emergency service).…”

Avaliação da linha de cuidado da pessoa com doença renal crônica: do itinerário terapêutico do usuário à revisão comparada com sistemas de saúde internacionais

“…De forma geral, observase que, mesmo entre países em estágios similares de desenvolvimento econômico, ou ainda entre estados ou províncias de um mesmo país, existem variações importantes nos modelos de alocação de pessoal e de infraestrutura, que são profundamente dependentes das políticas internas de cada nação. 25,29 Em regiões de média e baixa renda, observa-se um número inadequado de profissionais de saúde e uma ausência generalizada de instalações de tratamento e de métodos para avaliação da função renal e triagem de pacientes. 20,21 A pesquisa realizada por Bello et al, envolvendo dados de 125 países, representando cerca de 93% (6.8 bilhões) da população mundial, enfatiza a grande variabilidade inter-regional e intrarregional na capacidade atual de cuidados renais em todo o mundo.…”

“…Nos EUA, a maior parte das pessoas é dependente de seguros de saúde pessoais ou fornecidos por empregadores. 23,24,25 Ambos os países têm buscado políticas para ampliar o acesso à saúde para pacientes renais. Nos EUA, por exemplo, os sistemas Medicare e Medcaid passaram a incluir recentemente várias medicações importantes para pacientes renais no pacote de reembolso.…”

“…24 Da mesma forma, as políticas públicas naquele país têm encorajado o uso de diálise domiciliar, sempre que possível, buscando a melhoria da saúde e a redução de custos para os pacientes e para o governo. 25 Categoria temática 2. Acesso à atenção à saúde renal ou à abordagem da doença renal crônica Subtema 1.…”