The authority of courage and compassion: Healthcare policy leadership in addressing the kidney disease public health epidemic.

Franklin W Maddux

doi:10.1111/sdi.12849

Abstract

Recent developments in US kidney‐related healthcare policy have made chronic kidney disease (CKD) a societal focus in the United States. In the biggest policy change since the 1972 Social Security Amendments that extended Medicare coverage to patients with kidney failure regardless of age, a 2019 presidential executive order pledged to reduce end‐stage kidney disease, slow CKD progression, increase kidney transplants, and focus on home dialysis care. This manuscript seeks to outline key factors that can enable this milestone moment to evolve a policy framework that improves the health of society while being economically sustainable. Understanding the sociohistorical context of healthcare policy and the related lessons learned demonstrates that policy must take a broader view of the societal and system wide factors that affect chronic illness. Addressing the full breadth of the CKD epidemic requires looking at factors from both inside and outside traditional medical‐pathophysiological environments, including social determinants of health. This more fulsome insight will enable policy to better align the broad range of people and organizations who are working to combat the disease. By creating patient‐centered policy that both evolves with the speed of innovation and addresses root causes of CKD instead of narrowly focusing on symptoms or comorbidities alone, leaders in the public square have an historic opportunity to thoughtfully create the common ground of a lasting policy legacy that improves society's health today and for generations to come.

Highlights

How can leaders affect healthcare policy that is sustainable while improving society at large? At its heart, the question policy makers have wrestled with for the better part of the last century is what society will tolerate in terms of preventable illness and death, balanced against our collective tolerance for the expense
The 2010 introduction of the Patient Protection and Affordable Care Act (ACA) would stimulate value-based care models to enable providers and healthcare organizations to reconsider how to address the full Chronic kidney disease (CKD) continuum, not just kidney failure
The narrow focus of the 1972 Medicare policy solely on end-stage kidney disease (ESKD) and not the full CKD spectrum had three distinct deficiencies: (a) it did not address root cause-solutions for factors that would contribute to the rise of CKD as a population health epidemic, and instead narrowly focused on one singular part of a much broader health problem; (b) it did not allow for a true understanding of the actual costs involved and the total economic impact of the disease's full spectrum; and (c) it did not address factors contributing to skyrocketing CKD growth and related population health implications, or keep pace with new innovations and emerging science in the field

Summary

Introduction

How can leaders affect healthcare policy that is sustainable while improving society at large? At its heart, the question policy makers have wrestled with for the better part of the last century is what society will tolerate in terms of preventable illness and death, balanced against our collective tolerance for the expense. This perspectives manuscript is an attempt to address the question surrounding kidney care-related healthcare policy in the United States, first looking at the evolution of our health system generally, and at how a focused approach can enable a path forward to lasting, effective policy.

Results

Conclusion