Healthcare systems and end-stage renal disease (ESRD) therapies - an international review: access to ESRD treatments

Assessment of healthcare technology and economics can be used to assess the access to healthcare, its quality and efficacy as well as its cost and cos t efficiency. This report addresses these issues for the provision of care for end-stage renal disease (ESRD) patients. An international comparison of access to ESRD treatment modalities was made with reference to the healthc are provider structure in a range of industrial countries. The countries we re grouped into 'public' (Beveridge model),'mixed' (Bismarck model) and 'pr ivate' (Private Insurance model). In 'public' provider countries, 20-52% of dialysis patients are treated with home therapies (haemodialysis and perit oneal dialysis), and the number of patients with renal transplants is 45-81 % of all ESRD patients. In 'mixed' provider countries, only 9-17% of all di alysis patients are treated with home therapies, and 20-48% of ESRD patient s have renal transplants. In 'private' provider countries, 17% of US and 6% Japanese dialysis patients are treated with home therapies. Japan has 0.3% and the US has 26% of ESRD patients who receive renal transplants. It thus seems that provider structure influences access to and choice of ESRD trea tment. With a growing elderly population and longer life expectancy, there will be an increased requirement for ESRD treatments in all industrial coun tries. Equal access to, and quality of ESRD care in the future will require adequate funding and reimbursement strategies in a cost-constrained health care environment.