Policy analysis for end-stage renal disease in Jamaica

We developed and applied methods for policy analysis for end-stage renal di sease (ESRD) in Jamaica. Our emphasis was on methods useful for situations often found in developing countries, where both resources and data may be l imited. Many countries are experimenting with ESRD treatment options, but l ittle analysis has been done regarding how developing countries should appr oach policy decisions for ESRD. Methods for policy analysis in high-income countries often rely on large da ta sets that may be unavailable or only partially available in developing c ountries. We conducted technical analysis applicable in these circumstances and emphasized a process for including a wide range of policymakers and ot her stakeholders in both quantitative and qualitative aspects of the analys is. Our methods may also be applicable in other developing countries and fo r other chronic diseases. Our analysis included eight issues: (1) a review of currently available cli nical and scientific understanding regarding ESRD; (2) a review of country- specific socioeconomic and clinical issues relevant to ESRD in Jamaica; (3) estimates of the magnitude of the need for treatment in the Jamaican popul ation; (4) comparison of the need with available treatment capacity; (5) co st analysis related to options for expansion of treatment capacity; (6) com parison of costs to government budget resources and other potential sources of financing; (7) development of policy options; and (8) sensitivity testi ng of policy scenarios and trade-offs with competing priorities. We also identified several key decisions most developing country government s will face in setting health policy for ESRD, These include allocating fun ds for ESRD, identifying and selecting cost-saving clinical strategies, rat ioning available treatment capacity, and identifying the appropriate role f or public education. (C) 1999 Elsevier Science Ltd. All rights reserved.