Financing the episodes of care in nephrology

In France, serious difficulties exist in the management of patients suffering from chronic kidney disease: insufficient prevention, inequalities in access to transplantation, insufficient development of autonomous dialysis. The explanations are multifactorial but partly involve the procedures for remunerating professionals and health care facilities. To solve these problems related to the financing method, discussions have been underway for several years on the implementation of bundle payment, including all care and services. However, this evolution presents limits and risks for the quality of care, requiring the implementation of a precise framework in terms of guidelines and quality indicators, an efficient information and evaluation system, and a more integrated organization of care. During 2019, it is planned to carry out experiments on certain models of bundle payments for chronic kidney disease.