Baylor College of Medicine, Section of Nephrology, Houston, TX; Baker Institute for Public Policy, Rice University, Houston, TX.
Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI.
Adv Chronic Kidney Dis. 2022 Jan;29(1):65-75. doi: 10.1053/j.ackd.2022.01.002.
While patients with end-stage kidney disease have benefited from innovations in clinical therapeutics and care delivery, these changes have been primarily incremental and have not fundamentally transformed care delivery. Dialysis markets are highly concentrated, which may impede innovation. Unique features of the dialysis industry that have contributed to consolidation can help to explain links between consolidation and innovation. We discuss these unique features and then provide a framework for considering the effects of consolidation on innovation in dialysis that focuses on the following economic considerations: (1) industry characteristics, composition, and stage of consolidation, (2) innovation characteristics and relative profitability, (3) the role of government regulation, and (4) innovation from smaller providers and new entrants. We present examples of how these considerations have influenced the adoption of alternative dialysis technologies such as peritoneal dialysis and erythropoietin-stimulating agents, and we discuss how consolidated markets can both help and hinder recent policy initiatives to transform dialysis care delivery. Only by considering these important drivers of consolidation, future efforts can be successful in transforming end-stage kidney disease care.
虽然终末期肾病患者受益于临床治疗和护理提供方面的创新，但这些变化主要是渐进式的，并未从根本上改变护理提供方式。透析市场高度集中，这可能会阻碍创新。促成整合的透析行业的独特特征有助于解释整合与创新之间的联系。我们讨论了这些独特的特征，然后提供了一个框架来考虑透析行业整合对创新的影响，该框架侧重于以下经济考虑因素：（1）行业特征、组成和整合阶段，（2）创新特征和相对盈利能力，（3）政府监管的作用，以及（4）来自较小提供商和新进入者的创新。我们介绍了这些考虑因素如何影响替代透析技术（如腹膜透析和促红细胞生成素刺激剂）的采用的例子，并讨论了整合市场如何帮助和阻碍最近改变透析护理提供的政策举措。只有考虑到这些推动整合的重要因素，未来的努力才能成功改变终末期肾病的护理方式。
