Introduction:
Chronic Kidney Disease (CKD) affects more than 10% of the global population. CKD is a progressive disease that represents an enormous financial burden on patients and healthcare systems. In order to properly address CKD, it is crucial to examine the features of national healthcare systems, their distinct treatment plans, and their care of CKD patients. This paper compares the healthcare systems of a developed country (the United States) and a developing country (India), accounting for the distinct demographics, infrastructure, and social dynamics of each individual country.
Methods:
A detailed literature review was conducted, examining research works, government policy and guideline documentation. Specifically, CKD care in the US and India was compared as it relates to structure and functioning, cost of treatment, availability of primary care physicians and nephrologists, healthcare capacity in rural and urban areas, patient awareness, and insurance frameworks. Gaps were identified in both the US and Indian healthcare systems.
Results:
The US Healthcare System is fragmented with different co-existing forms of public and private insurance. Even so, 8.4% of the US population remains uninsured. Care is provided by both public and private hospitals, and CKD patients are typically referred to nephrologists by primary care physicians. The Indian healthcare provider structure consists of public and private health care facility networks in a three-tier structure, in rural and urban areas, with private facilities typically in urban areas. About 70% of the Indian population is covered under public or private health insurance. 30% of the Indian population is uninsured. There is inadequate availability of nephrologists in both countries. The shortage is acute in India with only 2600 nephrologists (as of 2021) for 140 million CKD patients. While the cost of treatment is lower in India, it is a significant percentage of the GDP per capita, and the majority of Indian citizens are strained financially from high out of pocket costs. Both in the US and India, rural communities have much lower access to physicians. In the US, while 20% of the population lives in rural areas, only 10% of US physicians practice in rural communities. In India, rural communities (over 66% of the population) receive their healthcare primarily through Primary Health Centers and their Sub-Centers, which have inadequate healthcare staff. This severely limits the ability of rural patients in both the US and India to seek timely and adequate care. The emphasis on treating rather than preventing diseases is prevalent in the US healthcare system. This is partially caused by an inadequate number and distribution of primary care physicians (1 per 1598 patients). In India, there are measures such as the Ayushman Bharat plan being implemented to provide comprehensive primary healthcare. Lastly, patient awareness needs to be improved in both nations.
Conclusions:
The gaps identified in each healthcare system were observed to result in a lack of adequate treatment access for CKD patients in both the US and India which has a profound impact on the prevalence and progression of CKD. Governments and their healthcare agencies must work to ensure that their programs address the needs of the patient population and reflect the links between CKD detection, progression, and the structure and functioning of healthcare systems.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.