The economics of end-stage renal disease care in Canada: incentives and impact on delivery of care

  • Braden J. Manns
  • David C. Mendelssohn
  • Kenneth J. Taub
Article

Abstract

Examining international differences in health outcomes for end-stage renal disease (ESRD) patients requires an understanding of ESRD funding structures. In Canada, funding for all aspects of dialysis and transplant care, with the exception of drugs (for which supplementary insurance can be purchased), is provided for all citizens. Although ESRD programs across Canada’s 10 provinces differ in funding structure, they share important economic characteristics, including being publicly funded and universal, and providing most facets of ESRD care for free. This paper explains how ESRD care fits into the Canadian health care system, describes the epidemiology of ESRD in Canada, and offers economic explanations for international discrepancies.

Keywords

End-stage renal disease Dialysis Health care financing Medical costs Reimbursement Canada 

JEL Classification

I10 I11 I12 I18 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Alberta Blue Cross. (2005). Alberta health and wellness drug benefit list, 2005. Edmonton: Alberta Blue Cross. Retrieved September, 2005, at http://www.ab.bluecross.ca/dbl/publications.html.Google Scholar
  2. Bargman J.M., Bick J., Cartier P., Dasgupta M.K., Fine A., Lavoie S.D., Spanner E., Taylor P.A. (1999) Guidelines for adequacy and nutrition in peritoneal dialysis. Journal of the American Society of Nephrology 10(Suppl 13): S311–S321Google Scholar
  3. Casadevall N., Nataf J., Viron B., Kolta A., Kiladjian J.J., Martin-Dupont P., Michaud P., Papo T., Ugo V., Teyssandier I., Varet B., Mayeux P. (2002) Pure red-cell aplasia and antierythropoietin antibodies in patients treated with recombinant erythropoietin. New England Journal of Medicine 346: 469–475CrossRefGoogle Scholar
  4. Churchill D.N., Blake P.G., Jindal K.K, Toffelmire E.B., Goldstein M.B. (1999) Clinical practice guidelines for initiation of dialysis. Journal of the American Society of Nephrology 10(Suppl 13): S289–S291Google Scholar
  5. CIHI. (2002). From perceived surplus to perceived shortage: What happened to Canada’s physician workforce in the 1990’s? Ottawa: Canadian Institute for Health Information.Google Scholar
  6. CIHI. (2003). Health care in Canada. Ottawa: Canadian Institute for Health Information.Google Scholar
  7. CIHI. (2004). Average payment per physician report, Canada, 2002–2003. Ottawa: Canadian Institute for Health Information.Google Scholar
  8. CIHI. (2005). Treatment of end-stage organ failure in Canada 2002 and 2003. Ottawa: Canadian Organ Replacement Register, Canadian Institute for Health Information.Google Scholar
  9. Culleton, B. F., Gautam, M., Peterson, J., McVeigh, E., & Hons, R. (2003). Anemia management in hemodialysis patients is improved with a nurse-managed algorithm. Presented at the American Society of Nephrology Annual Meeting, San Diego.Google Scholar
  10. Curtis B.M., Barrett B.J., Jindal K., Parfrey P. (2002) Canadian survey of clinical status at dialysis initiation 1998–1999: A multicenter prospective survey. Clinical Nephrology 58: 282–288Google Scholar
  11. Curtis B.M., Ravani P., Malberti F., Kennett F., Taylor P.A., Djurdjev O., Levin A. (2005) The short- and long-term impact of multi-disciplinary clinics in addition to standard nephrology care on patient outcomes. Nephrology Dialysis and Transplantation 20(1): 147–154CrossRefGoogle Scholar
  12. Dember L.M., Holmberg E.F., Kaufman J.S. (2004) Randomized controlled trial of prophylactic repair of hemodialysis arteriovenous graft stenosis. Kidney International 66: 390–398CrossRefGoogle Scholar
  13. Deziel C., Hirsch D.J., Hoult P., Levin A., Sohi P., Taub K.J., Watson D. (1999) Clinical practice guidelines for the delivery of hemodialysis. Journal of the American Society of Nephrology 10(Suppl 13): S306–S310Google Scholar
  14. Dor, A., Pauly, M. V., Eichleay, M. A., & Held, P. J. (2007). End-stage renal disease and economic incentives: The International Study of Health Care Organization and Financing (ISHCOF). International Journal of Health Care Finance and Economics. DOI: 10.1007/s10754-007-9024-9Google Scholar
  15. ERA-EDTA (2004). ERA-EDTA registry 2002 annual report. Amsterdam: Academic Medical Center.Google Scholar
  16. Ethier J.H., Lindsay R.M., Barre P.E., Kappel J.E., Carlisle E.J., Common A. (1999) Clinical practice guidelines for vascular access. Journal of the American Society of Nephrology 10(Suppl 13): S297–S305Google Scholar
  17. Fenton S.S., Schaubel D.E., Desmeules M., Morrison H.I., Mao Y., Copleston P., Jeffery J.R., Kjellstrand C.M. (1997) Hemodialysis versus peritoneal dialysis: A comparison of adjusted mortality rates. American Journal of Kidney Diseases 30: 334–342Google Scholar
  18. Foley R.N., Parfrey P.S., Harnett J.D., Kent G.M., O’Dea R., Murray D.C., Barre P.E. (1998) Mode of dialysis therapy and mortality in end-stage renal disease. Journal of the American Society of Nephrology 9: 267–276CrossRefGoogle Scholar
  19. Goeree R., Manalich J., Grootendorst P., Beecroft M.L., Churchill D.N. (1995) Cost analysis of dialysis treatments for end-stage renal disease (ESRD). Clinical and Investigative Medicine 18: 455–464Google Scholar
  20. Goldstein M., Yassa T., Dacouris N., McFarlane P. (2005) Multidisciplinary predialysis care and morbidity and mortality of patients on dialysis. American Journal of Kidney Diseases 44: 706–714CrossRefGoogle Scholar
  21. Hemmelgarn B.R., Zhang J., Manns B.J., Tonelli M., Larsen E., Ghali W.A., Southern D.A., McLaughlin K., Mortis G., Culleton B.F. (2006) Progression of kidney dysfunction in the community-dwelling elderly. Kidney International 69(12): 2155–2161CrossRefGoogle Scholar
  22. Ifudu O., Dawood M., Homel P., Friedman E.A. (1998) Timing of initiation of uremia therapy and survival in patients with progressive renal disease. American Journal of Nephrology 18: 193–198CrossRefGoogle Scholar
  23. Jindal K.K., Chan C.T., Deziel C., Hirsch D., Soroko S.D., Tonelli M., Culleton B.F. (2006a) Chapter 1: Hemodialysis adequacy in adults. Journal of the American Society of Nephrology 17 (Suppl 1): S4–S7Google Scholar
  24. Jindal K.K., Chan C.T., Deziel C., Hirsch D., Sorokoa S.D., Tonelli M., Cullenton B.F. (2006b) Chapter 2: Management of blood pressure in hemodialysis patients. Journal of the American Society of Nephrology 17(Suppl 1): S8–S10Google Scholar
  25. Jindal K.K., Chan C.T., Deziel C., Hirsch D., Sorokoa S.D., Tonelli M., Cullenton B.F. (2006c) Chapter 3: Mineral metabolism. Journal of the American Society of Nephrology 17(Suppl 1): S11–S15Google Scholar
  26. Jindal K.K., Chan C.T., Deziel C., Hirsch D., Soroko S.D., Tonelli M., Culleton B.F. (2006d) Chapter 4: Vascular access. Journal of the American Society of Nephrology 17(Suppl 1): S16–S23Google Scholar
  27. Jindal K.K., Chan C.T., Deziel C., Hirsch D., Sorokoa S.D., Tonelli M., Cullenton B.F. (2006e) Chapter 5: Frequent and sustained hemodialysis. Journal of the American Society of Nephrology 17 (Suppl 1): S24–S27Google Scholar
  28. Jindal K.K., Ethier J., Lindsay R.M., Barre P., Kappel J., Carlisle E., Common A. (1999) Clinical practice guidelines for vascular access. Journal of the American Society of Nephrology 10: S287–S321Google Scholar
  29. Kjellstrand C.M., Moody H. (1994) Hemodilaysis in Canada: A first-class medical crisis. Canadian Medical Association Journal 150: 1067–1071Google Scholar
  30. Laupacis A., Keown P., Pus N., Krueger H., Ferguson B., Wong C.M., Muirhead N. (1996) A study of the quality of life and cost-utility of renal transplantation. Kidney International 50: 235–242CrossRefGoogle Scholar
  31. Lee H., Manns B.J., Taub K., Ghali W., Dean S., Johnson D., Donaldson C. (2002) Cost analysis of ongoing care of patients with end-stage renal disease: The impact of dialysis modality and dialysis access. American Journal of Kidney Diseases 40: 611–622CrossRefGoogle Scholar
  32. Levin A., Lewis M., Mortiboy P., Faber S., Hare I., Porter E.C., Mendelssohn D.C. (1997) Multidisciplinary predialysis programs: quantification and limitations of their impact on patient outcomes in two Canadian settings. American Journal of Kidney Diseases 29: 533–540Google Scholar
  33. Manns B.J., Mortis G., Taub K., McLaughlin K., Donaldson C., Ghali W.A. (2001) The southern Alberta renal program database: A prototype for patient management and research initiatives. Clinical and Investigative Medicine 24(4): 164–170Google Scholar
  34. Manns B., Taub K., Donaldson C. (2000) Economic evaluation and end-stage renal disease: Rrom basics to bedside. American Journal of Kidney Diseases 36: 12–28Google Scholar
  35. Manns B.J., Taub K., Richardson R., Donaldson C. (2002) To reuse or not to reuse? An economic evaluation of hemodialyser reuse vs. conventional single use hemodialysis for chronic hemodialysis patients. International Journal of Technology Assessment in Health Care 18: 81–94Google Scholar
  36. Manns B., Tonelli M., Yilmaz S., Lee H., Laupland K., Klarenbach S., Radkevich V., Murphy B. (2005) Establishment and maintenance of vascular access in incident hemodialysis patients: A prospective cost analysis. Journal of the American Society of Nephrology 16: 201–209CrossRefGoogle Scholar
  37. McKenzie J.K., Moss A.H., Feest T.G., Stocking C.B., Siegler M. (1998) Dialysis decision making in Canada, the United Kingdom, and the United States. American Journal of Kidney Diseases 31: 12–18Google Scholar
  38. McMahon M., Morgan S., Mitton C. (2005) The common drug review: A NICE start for Canada? Health Policy 77(3): 339–351CrossRefGoogle Scholar
  39. Mendelssohn D.C., Barrett B.J., Brownscombe L.M., Ethier J., Greenberg D.E., Kanani S.D., Levin A., Toffelmire E.B. (1999) Elevated levels of serum creatinine: Recommendations for management and referral. Canadian Medical Association Journal 161: 413–417Google Scholar
  40. Mendelssohn D.C., Chery A. (1994) Dialysis utilization in the Toronto region from 1981 to 1992: Toronto Region Dialysis Committee. Canadian Medical Association Journal 150: 1099–1105Google Scholar
  41. Mendelssohn D.C., Ethier J., Elder S.J., Saran R., Port F.K., Pisoni R.L. (2006b) Hemodialysis vascular access problems in Canada: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS II). Neprhrology Dilaysis and Transplantation 21(3): 721–728CrossRefGoogle Scholar
  42. Mendelssohn D.C., Langlois N., Blake P.G. (2004) Peritoneal dialysis in Ontario: a natural experiment in physician reimbursement methodology. Peritoneal Dialysis International 24: 531–537Google Scholar
  43. Mendelssohn D.C., Toffelmire E.B., Levin A. (2006c) Attitudes of Canadian nephrologists toward multidicisplinary team-based CKD clinic care. American Journal of Kidney Diseases 47: 277–284CrossRefGoogle Scholar
  44. Mendelssohn D.C., Yeates K., Ethier J., Trpeski L., Na Y., Bragg-Gresham J.L., Eichleay M.A., Pisoni R.L., Port F.K. (2007) DOPPS estimate of patient life years attributable to modifiable hemodialysis practices in Canada. Nephrology News and Issues 21(5): 69–85Google Scholar
  45. Murphy S.W., Foley R.N., Barrett B.J., Kent G.M., Morgan J., Barre P., Campbell P., Fine A., Goldstein M.B., Handa S.P., Jindal K. K., Levin A., Mandin H., Muirhead N., Richardson R.M., Parfrey P.S. (2000) Comparative hospitalization of hemodialysis and peritoneal dialysis patients in Canada. Kidney International 57: 2557–2563CrossRefGoogle Scholar
  46. Nissenson A.R., Prichard S.S., Cheng I.K.P. (1993) Non-medical factors that impact on ESRD modality selection. Kidney International 43(Suppl 40): S120–S127Google Scholar
  47. NKF. (1997). NKF-DOQI clinical practice guidelines for the treatment of anemia of chronic renal failure. American Journal of Kidney Diseases, 30, S192–S240.Google Scholar
  48. NKF. (2001). NKF-DOQI clinical practice guidelines for vascular access: Update 2000. American Journal of Kidney Diseases, 37, S137–S181.Google Scholar
  49. OECD. (2006). Purchasing power parities (PPPs) for OECD countries 1980–2005. Paris: Organization for Economic Cooperation and Development. Retreived April 28, 2006, at http://www.oecd.org/dataoecd/61/56/1876133.xls.Google Scholar
  50. Pisoni R.L., Bragg-Gresham J.L., Young E.W., Akizawa T., Asano Y., Locatelli F., Bommer J., Cruz J.M., Kerr P.G., Mendelssohn D.C., Held P.J., Port F.K. (2004) Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases 44(1): 94–111CrossRefGoogle Scholar
  51. Pisoni R.L., Gillespie B.W., Dickinson D.M., Chen K., Kutner M., Wolfe R.A. (2004) The dialysis outcomes and practice patterns study: Design, data elements, and methodology. American Journal of Kidney Diseases 44(Suppl 2): S7–S15CrossRefGoogle Scholar
  52. Ram S.J., Work J., Caldito G.C., Eason J.M., Pervez A., Paulson W.D. (2003) A randomized controlled trial of blood flow and stenosis surveillance of hemodialysis grafts. Kidney International 64: 272–280CrossRefGoogle Scholar
  53. Scott’s Medical Database (2001). Supply, distribution and migration of Canadian physicians, 2001. Ottawa: Canadian Institute for Health Information.Google Scholar
  54. Sekkarie M., Cosma M., Mendelssohn D.C. (2001) Nonreferral and nonacceptance to dialysis by primary care physicians and nephrologists in Canada and the United States. American Journal of Kidney Diseases 38: 36–41Google Scholar
  55. Tonelli M., Klarenbach S., Manns B., Culleton B., Hemmelgarn B., Bertazzon S., Wiebe N., Gill J. (2006) Alberta kidney disease network, residence location and likelihood of kidney transplantation. Canadian Medical Association Journal 175: 478–482CrossRefGoogle Scholar
  56. USRDS. (2003). United States renal data system 2003 annual data report: Atlas of end-stage renal disease in the United States. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Google Scholar
  57. USRDS. (2004). United States renal data system 2004 annual data report: Atlas of end-stage renal disease in the United States. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Google Scholar
  58. USRDS. (2005). United States renal data system 2005 annual data report: Atlas of end-stage renal disease in the United States. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Google Scholar
  59. Walsh M., Culleton B., Tonelli M., Manns B. (2005) A systematic review of the effect of nocturnal hemodialysis on blood pressure, left ventricular hypertrophy, anemia, mineral metabolism, and health-related quality of life. Kidney International 67: 1500–1508CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Braden J. Manns
    • 1
    • 2
    • 3
  • David C. Mendelssohn
    • 4
  • Kenneth J. Taub
    • 1
  1. 1.Department of MedicineUniversity of CalgaryCalgaryCanada
  2. 2.Department of Community Health SciencesUniversity of CalgaryCalgaryCanada
  3. 3.Institute of Health EconomicsEdmontonCanada
  4. 4.Humber River Regional HospitalUniversity of TorontoWestonCanada

Personalised recommendations