TY - JOUR
T1 - Current status of health systems financing and oversight for end-stage kidney disease care
T2 - A cross-sectional global survey
AU - Yeung, Emily
AU - Bello, A. K.
AU - Levin, Adeera
AU - Lunney, Meaghan
AU - Osman, Mohamed A.
AU - Ye, Feng
AU - Ashuntantang, Gloria
AU - Bellorin-Font, Ezequiel
AU - Benghanem Gharbi, Mohammed
AU - Davison, Sara
AU - Ghnaimat, Mohammad
AU - Harden, Paul
AU - Jha, Vivekanand
AU - Kalantar-Zadeh, Kamyar
AU - Kerr, Peter
AU - Klarenbach, Scott
AU - Kovesdy, Csaba
AU - Luyckx, Valerie
AU - Neuen, Brendon
AU - O'Donoghue, Donal
AU - Ossareh, Shahrzad
AU - Perl, Jeffrey
AU - Ur Rashid, Harun
AU - Rondeau, Eric
AU - See, Emily
AU - Saad, Syed
AU - Sola, Laura
AU - Tchokhonelidze, Irma
AU - Tesar, Vladimir
AU - Tungsanga, Kriang
AU - Turan Kazancioglu, Rumeyza
AU - Wang, Angela Yee Moon
AU - Wiebe, Natasha
AU - Yang, Chih Wei
AU - Zemchenkov, Alexander
AU - Zhao, Minhui
AU - Jager, Kitty J.
AU - Caskey, Fergus
AU - Perkovic, Vlado
AU - Jindal, Kailash
AU - Okpechi, Ikechi G.
AU - Tonelli, Marcello
AU - Feehally, John
AU - Harris, David C.H.
AU - Johnson, David
N1 - Funding Information:
The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - The 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. A cross-sectional global survey. Key stakeholders from 182 countries were invited to participate. Of those, stakeholders from 160 countries participated and were included. Primary 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. 160 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. Significant 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.
AB - The 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. A cross-sectional global survey. Key stakeholders from 182 countries were invited to participate. Of those, stakeholders from 160 countries participated and were included. Primary 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. 160 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. Significant 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.
KW - chronic renal failure
KW - dialysis
KW - end stage renal failure
KW - epidemiology
KW - health economics
KW - organisation of health services
UR - http://www.scopus.com/inward/record.url?scp=85109926501&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-047245
DO - 10.1136/bmjopen-2020-047245
M3 - Article
C2 - 34244267
AN - SCOPUS:85109926501
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 7
M1 - e047245
ER -