Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
International Journal of Health Care Finance and Economics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • 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.

  • 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–S321

    Google Scholar 

  • 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: 469–475

    Article  Google Scholar 

  • 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–S291

    Google Scholar 

  • 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.

  • CIHI. (2003). Health care in Canada. Ottawa: Canadian Institute for Health Information.

  • CIHI. (2004). Average payment per physician report, Canada, 2002–2003. Ottawa: Canadian Institute for Health Information.

  • CIHI. (2005). Treatment of end-stage organ failure in Canada 2002 and 2003. Ottawa: Canadian Organ Replacement Register, Canadian Institute for Health Information.

  • 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.

  • 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: 282–288

    Google Scholar 

  • 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): 147–154

    Article  Google Scholar 

  • Dember L.M., Holmberg E.F., Kaufman J.S. (2004) Randomized controlled trial of prophylactic repair of hemodialysis arteriovenous graft stenosis. Kidney International 66: 390–398

    Article  Google Scholar 

  • 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–S310

    Google Scholar 

  • 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/s10754-007-9024-9

  • ERA-EDTA (2004). ERA-EDTA registry 2002 annual report. Amsterdam: Academic Medical Center.

  • 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–S305

    Google Scholar 

  • 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: 334–342

    Google Scholar 

  • 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: 267–276

    Article  Google Scholar 

  • 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: 455–464

    Google Scholar 

  • 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: 706–714

    Article  Google Scholar 

  • 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): 2155–2161

    Article  Google Scholar 

  • 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: 193–198

    Article  Google Scholar 

  • 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–S7

    Google Scholar 

  • 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–S10

    Google Scholar 

  • 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–S15

    Google Scholar 

  • 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–S23

    Google Scholar 

  • 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–S27

    Google Scholar 

  • 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–S321

    Google Scholar 

  • Kjellstrand C.M., Moody H. (1994) Hemodilaysis in Canada: A first-class medical crisis. Canadian Medical Association Journal 150: 1067–1071

    Google Scholar 

  • 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: 235–242

    Article  Google Scholar 

  • 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: 611–622

    Article  Google Scholar 

  • 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: 533–540

    Google Scholar 

  • 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): 164–170

    Google Scholar 

  • Manns B., Taub K., Donaldson C. (2000) Economic evaluation and end-stage renal disease: Rrom basics to bedside. American Journal of Kidney Diseases 36: 12–28

    Google Scholar 

  • 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: 81–94

    Google Scholar 

  • 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: 201–209

    Article  Google Scholar 

  • 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: 12–18

    Google Scholar 

  • McMahon M., Morgan S., Mitton C. (2005) The common drug review: A NICE start for Canada? Health Policy 77(3): 339–351

    Article  Google Scholar 

  • 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: 413–417

    Google Scholar 

  • 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: 1099–1105

    Google Scholar 

  • 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): 721–728

    Article  Google Scholar 

  • Mendelssohn D.C., Langlois N., Blake P.G. (2004) Peritoneal dialysis in Ontario: a natural experiment in physician reimbursement methodology. Peritoneal Dialysis International 24: 531–537

    Google Scholar 

  • 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: 277–284

    Article  Google Scholar 

  • 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): 69–85

    Google Scholar 

  • 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: 2557–2563

    Article  Google Scholar 

  • 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–S127

    Google Scholar 

  • 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 

  • NKF. (2001). NKF-DOQI clinical practice guidelines for vascular access: Update 2000. American Journal of Kidney Diseases, 37, S137–S181.

    Google Scholar 

  • 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.

  • 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): 94–111

    Article  Google Scholar 

  • 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–S15

    Article  Google Scholar 

  • 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: 272–280

    Article  Google Scholar 

  • Scott’s Medical Database (2001). Supply, distribution and migration of Canadian physicians, 2001. Ottawa: Canadian Institute for Health Information.

  • 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: 36–41

    Google Scholar 

  • 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: 478–482

    Article  Google Scholar 

  • 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.

  • 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.

  • 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.

  • 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: 1500–1508

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, University of Calgary, Calgary, T2N 2T9, AB, Canada

    Braden J. Manns & Kenneth J. Taub

  2. Department of Community Health Sciences, University of Calgary, Calgary, T2N 4N1, AB, Canada

    Braden J. Manns

  3. Institute of Health Economics, Edmonton, AB, Canada

    Braden J. Manns

  4. Humber River Regional Hospital, University of Toronto, Weston, ON, Canada

    David C. Mendelssohn

Authors
  1. Braden J. Manns
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David C. Mendelssohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenneth J. Taub
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Braden J. Manns.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Manns, B.J., Mendelssohn, D.C. & Taub, K.J. The economics of end-stage renal disease care in Canada: incentives and impact on delivery of care. Int J Health Care Finance Econ 7, 149–169 (2007). https://doi.org/10.1007/s10754-007-9022-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10754-007-9022-y

Keywords

JEL Classification

Search

Navigation