The economics of end-stage renal disease care in Canada: incentives and impact on delivery of care
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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
Published online: 20 July 2007 © Springer Science+Business Media, LLC 2007
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
Introduction Health care outcomes for end-stage renal disease (ESRD) patients in Canada are generally considered to be good, when international comparisons with the United States and other
B. J. Manns (B)· K. J. Taub Department of Medicine, University of Calgary, Calgary, T2N 2T9, AB, Canada e-mail: [email protected] B. J. Manns Department of Community Health Sciences, University of Calgary, Calgary, T2N 4N1, AB, Canada B. J. Manns Institute of Health Economics, Edmonton, AB, Canada D. C. Mendelssohn Humber River Regional Hospital, University of Toronto, Weston, ON, Canada
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European countries are made based on global indices such as patient survival (CIHI, 2005; ERA-EDTA, 2004; USRDS, 2004). When examining potential differences in health outcomes for ESRD patients across countries, it is important to consider how the funding structure for ESRD care might affect such outcomes, and the cost of achieving those outcomes. For instance, coverage for dialysis and transplantation is provided for all Canadian citizens, whereas coverage for novel, but unproven therapies, such as sevelamer or cinacalcet, may be limited or not available. How this might impact health outcomes for Canadian ESRD patients, in comparison to ESRD patients in other countries, requires consideration. In order to understand the funding for ESRD care in Canada, it is important to have a general understanding of how the health care system is structured and funded. Canada is a federation of ten provinces and three territories that share the responsibilities of governing the nation with the federal government. However, the provision of health care is a provincial (or territorial) responsibility; therefore, within each province health care is provided and funded in a slightly different fashion. Generally speaking, the funds for the publicly-funded component of health care are provided by each
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