Financial hardship, chronic kidney disease, and the case for policy action in Canada

Canada’s universal health care system is often held up as a safeguard against financial hardship caused by illness. Yet for many people living with chronic kidney disease (CKD), financial strain is a defining feature of their care journey. In the recently published article, Financial hardship amongst patients living with chronic kidney disease in Canada, a persistent, and largely invisible problem is highlighted: non-medical costs and income loss associated with CKD can profoundly shape health outcomes and quality of life of patients.

CKD is a lifelong, progressive condition that often leads to dialysis or transplant. While core medical services are publicly funded, patients encounter high out-of-pocket expenses and hidden costs associated with the illness. These include transportation to dialysis, prescription drugs not fully covered by provincial plans, specialized diets, costs related to treatment and the need for additional space for home dialysis. For many, these costs begin just as their capacity to work declines, particularly when dialysis starts and the burden of illness intensifies.

Tyler Murphy, a frontline renal social worker at William Osler Health System and lead author of the study, describes this period as a critical transition point. “Dialysis doesn’t just change someone’s medical routine,” she explains. “It often changes their entire financial reality.” Patients who were previously employed may find full-time work impossible due to treatment schedules, fatigue, or complications. Even when income support programs exist, navigating them can be fragmented, complex, and slow. Financial strain also compounds mental health challenges, which in turn affect overall health outcomes.

The research underscores that financial hardship is not simply a social issue; it is a clinical risk factor. Patients experiencing financial strain are more likely to delay or miss treatments, struggle with medication adherence, and report higher levels of stress, anxiety, and depression. These challenges contribute to poorer outcomes and increased mortality risk. If a patient misses dialysis because they need to work, they may be labeled “nonadherent” and excluded from transplant eligibility.

In Canada, this issue is particularly difficult to address because financial hardship is not routinely captured in patient data. “We’re very good at tracking lab values and hospital admissions,” Murphy notes, “but we don’t routinely measure whether someone can afford to get to their appointment or pay their rent.” As a result, financial distress often remains invisible until it escalates to crisis.

Caregivers are also affected. Family members may reduce their own work hours or leave employment altogether to provide support, further destabilizing household income. Illness and financial insecurity then reinforce one another in a cycle with long-term consequences for patients and families.

Canada does offer financial supports, including the federal disability program, provincial income assistance, tax credits, and charitable foundations. However, the research identifies significant gaps. Eligibility criteria are restrictive, benefit levels often fail to offset real costs, and application processes can be burdensome. Only about 15% of patients with CKD that are eligible and don't have private insurance are currently receiving disability benefits.

Timing is another structural barrier. Many supports are not available until a patient is formally deemed “disabled,” leaving individuals in early or transitional stages of CKD without adequate assistance. “There’s a window where people are getting sicker, working less, and spending more but they don’t yet qualify for support,” Murphy explains. By the time benefits are approved, financial crisis may already have occurred.

Geographic inequities further complicate the picture. Access to supports varies across provinces, and rural patients often face higher transportation costs and fewer local resources. These disparities raise important health equity concerns, particularly for Indigenous communities, newcomers, and individuals in precarious employment or precarious housing situations.

The findings point to a clear need for upstream policy action.

Financial hardship should be recognized as a core component of CKD care. Routine screening for financial strain, similar to screening for mental health or nutrition risk, could allow earlier intervention.

Income support policies could also better align with the realities of chronic illness. Flexible disability and employment insurance programs that account for work capacity could prevent patients from falling through the cracks. Streamlining application processes and improving coordination between federal and provincial systems would reduce administrative burden for individuals already navigating complex treatment pathways.

Importantly, targeted investments in transportation, medication coverage, and home-based dialysis supports could reduce avoidable hospitalizations and emergency department use, ultimately easing pressure on the health system.

Social workers are often the first to identify financial distress. Strengthening social work capacity within CKD care teams is a practical, evidence-informed strategy outlined in the report. Early engagement allows patients to anticipate income changes and access benefits sooner. “When we intervene early,” Murphy notes, “we can help people stabilize their finances and focus on their health.”

This research invites a broader conversation about how Canada supports people living with chronic illness. Addressing financial hardship requires collaboration beyond healthcare, including social services and community organizations.

At its core, this issue is about health equity. By recognizing financial strain as a determinant of health, Canada has an opportunity to improve outcomes not only for people with CKD, but for those living with chronic disease more broadly.

As this research and Murphy’s frontline experience make clear, universal health care alone is not sufficient. Supporting people with CKD requires policies and practices that acknowledge the full cost of living with chronic illness and ensure that no one’s health is compromised by their inability to pay.