A call to arms : Economic barriers to optimal dialysis care

• Published in: Peritoneal dialysis international Vol. 20; no. 1; pp. 7 - 12
• Main Authors: MCFARLANE, P. A, MENDELSSOHN, D. C
• Format: Journal Article
• Language: English
• Published: Milton, ON Multimed 2000
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Costs and Cost Analysis; Emergency and intensive care: renal failure. Dialysis management; Humans; Intensive care medicine; Medical sciences; Renal Dialysis - economics; Renal Dialysis - standards; Kidney disease; Human; Urinary system disease; Terminal stage; Cost control; Extrarenal dialysis; Objective; Health policy; Health economy; Renal failure; Evolution; Dialysis; Public health; Cost efficiency analysis
• ISSN: 0896-8608; 1718-4304
• DOI: 10.1177/089686080002000102

Epidemic growth rates and the enormous cost of dialysis pressure end-stage renal disease (ESRD) delivery systems around the world. Payers of dialysis services can constrain costs through (1) limiting access to dialysis, (2) reducing the quality of dialysis, and (3) placing constraints on modality distribution. In order to secure the necessary resources for ESRD care, we propose that the nephrology community consider the following suggestions: First, future leaders in dialysis should acquire additional advanced training in innovative pathways such as health care economics, business and health care administration, and health care policy. Second, the international nephrology community must strongly engage in ongoing advocacy for accessible, high quality, cost-effective care.Third, efforts should be made to better define and then implement optimal dialysis modality distributions that maximize patient outcomes but limit unnecessary costs. Fourth, industry should be encouraged to lower the unit cost of dialysis, allowing for improved access to dialysis, especially in developing countries. Fifth, research should be encouraged that seeks to identify measures that will reduce dialysis costs but will not impair quality of care. Finally, early referral of patients with progressive renal disease to nephrology clinics, empowerment of informed patient choice of dialysis modality, and proper and timely access creation should be encouraged and can be expected to help limit overall expenditures. Ongoing efforts in these areas by the nephrology community will be essential if we are to overcome the challenges of ESRD growth in this new decade.