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Title: Current status of health systems financing and oversight for end-stage kidney disease care: a cross-sectional global survey.
Austin Authors: Yeung, Emily;Bello, A K;Levin, Adeera;Lunney, Meaghan;Osman, Mohamed A;Ye, Feng;Ashuntantang, Gloria;Bellorin-Font, Ezequiel;Benghanem Gharbi, Mohammed;Davison, Sara;Ghnaimat, Mohammad;Harden, Paul;Jha, Vivekanand;Kalantar-Zadeh, Kamyar;Kerr, Peter;Klarenbach, Scott;Kovesdy, Csaba;Luyckx, Valerie;Neuen, Brendon;O'Donoghue, Donal;Ossareh, Shahrzad;Perl, Jeffrey;Ur Rashid, Harun;Rondeau, Eric;See, Emily J ;Saad, Syed;Sola, Laura;Tchokhonelidze, Irma;Tesar, Vladimir;Tungsanga, Kriang;Turan Kazancioglu, Rumeyza;Wang, Angela Yee-Moon;Wiebe, Natasha;Yang, Chih-Wei;Zemchenkov, Alexander;Zhao, Minhui;Jager, Kitty J;Caskey, Fergus;Perkovic, Vlado;Jindal, Kailash;Okpechi, Ikechi G;Tonelli, Marcello;Feehally, John;Harris, David Ch;Johnson, David
Affiliation: Division of Nephrology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
Monash Health, Clayton, Victoria, Australia
Population Health Sciences, University of Bristol, Bristol, UK
Department of Infection, Inflammation and Immunity, University of Leicester, Leicester, UK
Salford Royal Hospitals NHS Trust, Salford, UK
Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
Department of Internal Medicine, Saint Louis University, Saint Louis, Missouri, USA
Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California, USA
Nephrology, Memphis VA Medical Center, Memphis, Tennessee, USA
Department of Nephrology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
Department of Medicine, Monash University, Clayton, Victoria, Australia
The George Institute for Global Health, Newtown, New South Wales, Australia
Intensive Care
Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
Centre for Kidney Disease Research, The University of Queensland, Saint Lucia, Queensland, Australia
Metro South Integrated Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
Medicine, University of Alberta, Edmonton, Alberta, Canada
Division of Nephrology and Immunology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Intensive Care Nephrology and Transplantation Department, Assistance Publique-Hopitaux de Paris, Paris, France
George Institute for Global Health, New Dehli, India
Department of Nephrology, St Michael's Hospital, Toronto, Ontario, Canada
Department of Medicine, King Chulalong Memorial Hospital, Bangkok, Thailand
Bhumirajanagarindra Kidney Institute, Bangkok, Thailand
Oxford Kidney Unit, Oxford University Hospitals NHS Trust, Oxford, UK
Faculty of Medicine and Biomedical Sciences, University of Yaounde I Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon
Urinary Tract Diseases Department, University of Hassan II Casablanca Faculty of Science Ain Chock, Casablanca, Morocco
Department of Internal Medicine, The Specialty Hospital, Amman, Jordan
Institute of Biomedical Ethics and the History of Medicine, University of Zurich Institute of Biomedical Ethics History of Medicine, Zurich, Switzerland
Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia.
Department of Nephrology, Charles University, Praha, Czech Republic
Division of Nephrology, Bezmialem Vakif Universitesi, Istanbul, Turkey
Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
Kidney Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
Department of Internal Disease and Nephrology, North-Western State Medical University named after I I Mechnikov, Sankt-Peterburg, Russia
Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
Medicine, University of Cape Town, Cape Town, South Africa
Issue Date: 9-Jul-2021
Date: 2021-07-09
Publication information: BMJ Open 2021; 11(7): e047245
Abstract: 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.
DOI: 10.1136/bmjopen-2020-047245
ORCID: 0000-0002-1244-1044
Journal: BMJ Open
PubMed URL: 34244267
Type: Journal Article
Subjects: chronic renal failure
end stage renal failure
health economics
organisation of health services
Appears in Collections:Journal articles

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