Selgas, RafaelRodríguez, LauraJulián Mauro, Juan CarlosRemón, CésarPrieto-Velasco, MarioPérez-Contreras, JavierPérez-Fontán, Miguel2018-11-152018-11-152017-03-06Selgas R, Rodriguez L, Julian JC, Remon C, Prieto-Velasco M, Perez-Contreras J, Fontan MP; GADDPE. How a bottom-up multi-stakeholder initiative helped transform the renal replacement therapy landscape in Spain. Appl Health Econ Health Policy. 2017 Dec;15(6):755-762.1175-5652http://hdl.handle.net/2183/21318[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.engCreative Commons Attribution-NonCommercial 4.0 International License (CC-BY-NC 4.0)http://creativecommons.org/licenses/by-nc/4.0/Delivery of health careHealth care reformHealth policyNational health programsPatient-centered careQuality of health careRenal replacement therapySpainjournal articleopen access