A global overview of health system financing and available infrastructure and oversight for kidney care

Emily Yeung, Rohan Khanal, Abdulshahid Sarki, Silvia Arruebo, Sandrine Damster, Fergus J Caskey, Et Al

Research output: Contribution to journalArticle (Academic Journal)peer-review


Governance, health financing, and service delivery are critical elements of health systems for provision of robust and sustainable chronic disease care. We leveraged the third iteration of International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to evaluate oversight and financing for kidney care worldwide.
A survey was administered to stakeholders from countries affiliated with the ISN from July to September 2022. We evaluated funding models utilized for reimbursement of medications, services for the management of chronic kidney disease, and provision of kidney replacement therapy (KRT). We also assessed oversight structures and the delivery of kidney care.
Overall, 167 of the 192 countries and territories contacted responded to the survey, representing 97.4% of the global population. High-income countries tended to use public funding to reimburse all categories of kidney care in comparison to low-income countries (LICs) and lower-middle-income countries (LMICs). In countries where public funding for KRT was available, 78% provided universal health coverage. The proportion of countries that used public funding to fully reimburse care varied for non-dialysis chronic kidney disease (27%), dialysis for acute kidney injury (either hemodialysis [HD] or peritoneal dialysis [PD]) (44%), chronic HD (45%), chronic PD (42%), and kidney transplant medications (36%). Oversight for kidney care was provided at a national level in 63% of countries and at state/provincial levels in 28% of countries.
This study demonstrated significant gaps in universal care coverage, and oversight and financing structures for kidney care, particularly in in LICs and LMICs.
Original languageEnglish
JournalNephrology Dialysis Transplantation
Publication statusAccepted/In press - 24 Apr 2024


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