Selgas, RafaelRodriguez, LauraJulian, Juan CarlosRemon, CesarPrieto-Velasco, MarioPerez-Contreras, JavierFontan, Miguel PerezGADDPE2023-01-252023-01-252017http://hdl.handle.net/10668/10938Healthcare 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.enAttribution-NonCommercial 4.0 Internationalhttp://creativecommons.org/licenses/by-nc/4.0/Delivery of Health CareHealth Care ReformHealth PolicyHumansNational Health ProgramsPatient-Centered CareQuality of Health CareRenal Replacement TherapySpainresearch article28265820open access10.1007/s40258-017-0315-01179-1896PMC5701956https://link.springer.com/content/pdf/10.1007%2Fs40258-017-0315-0.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701956/pdf