PDF(Pubmed)
Abstract：
Worldwide the assistance on renal replacement therapy (RRT) is carried out mainly by private for-profit services and in a market with increase in mergers and acquisitions. The aim of this study was to conduct an integrative systematic review on privatization and oligopolies in the RRT sector in the context of contemporary capitalism. The inclusion criteria were scientific articles without language restrictions and that addressed the themes of oligopoly or privatization of RRT market. Studies published before 1990 were excluded. The exploratory search for publications was carried out on February 13, 2024 on the Virtual Health Library Regional Portal (VHL). Using the step-by-step of PRISMA flowchart, 34 articles were retrieved, of which 31 addressed the RRT sector in the United States and 26 compared for-profit dialysis units or those belonging to large organizations with non-profit or public ones. The main effects of privatization and oligopolies, evaluated by the studies, were: mortality, hospitalization, use of peritoneal dialysis and registration for kidney transplantation. When considering these outcomes, 19 (73%) articles showed worse results in private units or those belonging to large organizations, six (23%) studies were in favor of privatization or oligopolies and one study was neutral (4%). In summary, most of the articles included in this systematic review showed deleterious effects of oligopolization and privatization of the RRT sector on the patients served. Possible explanations for this result could be the presence of conflicts of interest in the RRT sector and the lack of incentive to implement the chronic kidney disease care line. The predominance of articles from a single nation may suggest that few countries have transparent mechanisms to monitor the quality of care and outcomes of patients on chronic dialysis.
摘要：
在世界范围内，肾脏替代疗法（RRT）的援助主要由私人营利性服务机构以及合并和收购增加的市场进行。这项研究的目的是在当代资本主义的背景下，对RRT部门的私有化和寡头垄断进行综合系统的审查。纳入标准是没有语言限制的科学文章，涉及寡头垄断或RRT市场私有化的主题。1990年以前发表的研究被排除在外。对出版物的探索性搜索于2024年2月13日在虚拟卫生图书馆区域门户（VHL）上进行。使用PRISMA流程图的逐步步骤，检索到34篇文章，其中31个涉及美国的RRT部门，26个比较营利性透析单位或属于大型组织的透析单位与非营利或公共组织的透析单位。私有化和寡头垄断的主要影响，通过研究评估，分别是：死亡率，住院治疗,使用腹膜透析和肾移植登记。当考虑到这些结果时，19篇(73%)文章在私营单位或属于大型组织的单位中表现较差，六项(23%)研究赞成私有化或寡头垄断，一项研究是中立的(4%)。总之,本系统综述中包含的大多数文章都显示了RRT部门的寡头垄断和私有化对所服务患者的有害影响.对此结果的可能解释可能是RRT部门存在利益冲突，并且缺乏实施慢性肾脏疾病护理系列的动力。来自单个国家的文章占主导地位可能表明，很少有国家拥有透明的机制来监测慢性透析患者的护理质量和结果。
