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Health policy for dialysis care in Canada and the United States

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Abstract
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.
Keywords
RENAL REPLACEMENT THERAPY, STAGE KIDNEY-DISEASE, FOR-PROFIT, FACILITY, OWNERSHIP, HEMODIALYSIS, OUTCOMES, ACCESS, REIMBURSEMENT, MANAGEMENT, QUALITY, dialysis, health policy, innovation, transnational comparisons, Kidney, Failure, Chronic, peritoneal dialysis, Renal Insufficiency, Health Care, Costs, Government

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MLA
Tonelli, Marcello, et al. “Health Policy for Dialysis Care in Canada and the United States.” CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, vol. 15, no. 11, 2020, pp. 1669–77, doi:10.2215/CJN.14961219.
APA
Tonelli, M., Vanholder, R., & Himmelfarb, J. (2020). Health policy for dialysis care in Canada and the United States. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 15(11), 1669–1677. https://doi.org/10.2215/CJN.14961219
Chicago author-date
Tonelli, Marcello, Raymond Vanholder, and Jonathan Himmelfarb. 2020. “Health Policy for Dialysis Care in Canada and the United States.” CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY 15 (11): 1669–77. https://doi.org/10.2215/CJN.14961219.
Chicago author-date (all authors)
Tonelli, Marcello, Raymond Vanholder, and Jonathan Himmelfarb. 2020. “Health Policy for Dialysis Care in Canada and the United States.” CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY 15 (11): 1669–1677. doi:10.2215/CJN.14961219.
Vancouver
1.
Tonelli M, Vanholder R, Himmelfarb J. Health policy for dialysis care in Canada and the United States. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY. 2020;15(11):1669–77.
IEEE
[1]
M. Tonelli, R. Vanholder, and J. Himmelfarb, “Health policy for dialysis care in Canada and the United States,” CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, vol. 15, no. 11, pp. 1669–1677, 2020.
@article{8686619,
  abstract     = {{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.}},
  author       = {{Tonelli, Marcello and Vanholder, Raymond and Himmelfarb, Jonathan}},
  issn         = {{1555-9041}},
  journal      = {{CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY}},
  keywords     = {{RENAL REPLACEMENT THERAPY,STAGE KIDNEY-DISEASE,FOR-PROFIT,FACILITY,OWNERSHIP,HEMODIALYSIS,OUTCOMES,ACCESS,REIMBURSEMENT,MANAGEMENT,QUALITY,dialysis,health policy,innovation,transnational comparisons,Kidney,Failure,Chronic,peritoneal dialysis,Renal Insufficiency,Health Care,Costs,Government}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{1669--1677}},
  title        = {{Health policy for dialysis care in Canada and the United States}},
  url          = {{http://dx.doi.org/10.2215/CJN.14961219}},
  volume       = {{15}},
  year         = {{2020}},
}

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