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Achieving equity in dialysis care and outcomes: The role of policies
Author(s) -
Crews Deidra C.,
Novick Tessa K.
Publication year - 2020
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12847
Subject(s) - medicine , dialysis , equity (law) , disadvantaged , health equity , referral , health care , prospective payment system , intensive care medicine , kidney transplantation , kidney disease , ethnic group , nephrology , end stage kidney disease , public health , transplantation , family medicine , nursing , economic growth , political science , law , economics
Socially disadvantaged persons, including racial and ethnic minorities, individuals with low incomes, homeless persons, and non‐US citizens bear a disproportionate burden of end‐stage kidney disease (ESKD). Inequities in nephrology referral, vascular access, use of home dialysis modalities, kidney transplantation, and mortality are prominent. Public policies, including the Patient Protection and Affordable Care Act, end‐stage renal disease Quality Incentive Program, and the Prospective Payment System, were enacted to improve healthcare access and dialysis care. Here, we highlight inequities in dialysis care and outcomes, how current ESKD and other public policies may influence or exacerbate these inequities, and gaps in the literature needed to inform future policies toward achieving equity in ESKD. We give special attention to the 2019 Advancing American Kidney Health Executive Order, which has high potential to radically transform dialysis care.