title: How a Bottom-Up Multi-Stakeholder Initiative Helped Transform the Renal Replacement Therapy Landscape in Spain.
abstract: Healthcare reforms aim to change certain parts of the health system to improve quality of care, access, or financial sustainability. Traditionally, healthcare reform is understood as an action undertaken by a government at a national or local level. However, bottom-up changes can also lead to improvements in the health system. This paper describes the efforts of a coordinated multi-stakeholder advocacy group in Spain to promote a more cost-effective and patient-centred treatment for people receiving renal replacement therapy and assesses the outcomes of their advocacy for health system financing and patient satisfaction. It concludes that bottom-up initiatives do indeed have the power to change health policy and that policy makers should pay attention to their arguments.
authors.affiliation: Department of Nephrology, IdiPAZ, Jefe del Servicio de Nefrología, Hospital Universitario La Paz, P. Castellana 261, 28046, Madrid, Spain. Rafael.selgas@salud.madrid.org.
authors.forename: Rafael
authors.initials: R
authors.lastname: Selgas
authors.affiliation: GADDPE Secretariat, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Rodriguez
authors.affiliation: ALCER Spanish Renal Patient Foundation, Madrid, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Julian
authors.affiliation: Department of Nephrology, Hospital Universitario de Puerto Real, Cádiz, Spain.
authors.forename: Cesar
authors.initials: C
authors.lastname: Remon
authors.affiliation: Department of Nephrology, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Prieto-Velasco
authors.affiliation: Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Perez-Contreras
authors.affiliation: Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: Miguel Perez
authors.initials: MP
authors.lastname: Fontan
mesh_terms: D003695:Delivery of Health Care / Q000191:economics*; D018166:Health Care Reform / Q000191:economics*; D006291:Health Policy / Q000191:economics*; D006801:Humans; D009313:National Health Programs / Q000191:economics*; D018802:Patient-Centered Care / Q000191:economics*; D011787:Quality of Health Care / Q000191:economics*; D017582:Renal Replacement Therapy / Q000191:economics*; D013030:Spain