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Dialysis services are expensive. Typically, a country spends 1 to 2% of its healthcare budget treating less than 0.1% of its population that requires dialysis (De Vecchi et al, 1999). In western countries, 90% of the patients are treated with haemodialysis in a dialysis centre attached or affiliated to a hospital. The literature shows that when given the choice, up to 50% of dialysis patients will prefer to perform the procedure at home (Jager et al, 2004, Goovaerts et al, 2005) . Performing dialysis at home can generate significant cost savings to high income country healthcare systems and societies while improving survival, reducing morbidity (i.e., dialysis-related complications, hospital acquired infection, etc.) and increasing patient’s quality of life. Furthermore, patients’ satisfaction with care is higher with home modalities (Fadem SZ, 2011). Home dialysis therefore represents an opportunity for healthcare systems to improve health gains in their population while reducing the cost per case of a dialysis patient. In a survey of 6595 nephrology healthcare professionals, 56% mentioned home/self-care modalities as the preferred long-term dialysis modalities (Ledebo & Ronco, 2008). Yet, in western countries only 10% of the patients are treated at home with either peritoneal dialysis or home haemodialysis. Canada, the Netherlands, the UK and the Scandinavian countries have a much higher (20-30%) usage of home modalities. Reimbursement and organization of renal care have often been cited as being responsible for the differences observed between countries. This chapter will review the organization and financing of dialysis in 14 countries and suggests a 4-pillar framework to explain the differences observed between countries. Correcting or addressing each of these 4 pillars will be essential for home modalities such as peritoneal dialysis to benefit a significant number of patients in a country. This chapter will propose a few avenues for this.

A Renal Policy and Financing Framework to Understand Which Factors Favour Home Treatments Such as Peritoneal Dialysis