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Nephrology in Canada

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Abstract

The Canadian health-care system is largely under provincial rather than federal jurisdiction. It is a unique single payer system in that essential medical services, including chronic dialysis and kidney transplantation, can only be funded publicly and private payment for them is not permitted. Private for-profit dialysis providers are almost nonexistent with most dialysis being delivered by academic and community hospitals. In some provinces these hospitals receive volume-related funding from the government with different rates for different dialysis modalities and for transplantation, while in others dialysis and transplant have to be paid for out of hospital global budgets, which come mainly from the government. Nephrologists are paid mainly by “fee for service,” even within universities, but with a modality-independent capitation model for chronic dialysis patient care being used in many provinces. There is an increasing tendency for provincial health ministries to establish provincial renal agencies to fund and to supervise quality in delivery of renal services. These agencies typically emphasize patient and physician participation in decision-making.

Incident and prevalent rates for end-stage renal disease are relatively high by international standards at 200 and 1350 per million population, respectively, but still much less than in the United States. Growth in end-stage renal disease rates has plateaued somewhat in the last two decades. Home dialysis penetration is relatively high at about 24% of which about 80% is accounted for by peritoneal dialysis. Transplant rates are also relatively high by international standards at 45–50 per million population with 35–40% being from living donors.

The country has about 700 nephrologists with the large majority now being Canadian medical school graduates. About half have academic appointments and half are community based. Over 90% do at least some care of patients on chronic dialysis. The specialty remains relatively popular with positions in the larger cities especially being in demand.

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Authors and Affiliations

  1. Western University, London, Ontario, Canada

    Peter G. Blake

  2. London Health Sciences Centre, London, Ontario, Canada

    Peter G. Blake

  3. Ontario Renal Network, Toronto, Ontario, Canada

    Peter G. Blake

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Editors and Affiliations

  1. Brazilian Society of Nephrology, Salvador, Bahia, Brazil

    José A. Moura-Neto

  2. Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Stockholms Län, Sweden

    José Carolino Divino-Filho

  3. DIMED - University of Padova, Department Nephrology Dialysis & Transplantation, International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

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Blake, P.G. (2021). Nephrology in Canada. In: Moura-Neto, J.A., Divino-Filho, J.C., Ronco, C. (eds) Nephrology Worldwide. Springer, Cham. https://doi.org/10.1007/978-3-030-56890-0_11

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