Is Medicare Rationing Dialysis Treatments?
October 6, 2003
Kidney dialysis, which cleans the blood of toxins in place of failed kidneys, is usually administered three times a week in outpatient clinics. There is evidence that many patients would benefit from more intensive treatment, say observers, but Medicare doesn't pay for it.
Some critics say the limited availability of home dialysis is evidence of health care rationing:
- Medicare pays for nearly all dialysis in the United States, regardless of the age of the patient, under a unique federal entitlement; the government spends more than $15 billion a year on dialysis and other treatment for kidney-failure patients.
- In 2001, the 292,000 people on dialysis, plus another 114,000 who had received a transplanted kidney, accounted for 6.4 percent of Medicare's $242 billion budget -- although they represented about 1 percent of Medicare's enrollees.
- Doctors estimate as many as half of the 300,000 people on dialysis in the United States might benefit from this treatment regime.
- Of 100 Americans on dialysis today, 23, on average, will be dead a year from now -- a worse mortality rate than breast or colon cancer. About a third survive five or more years.
- Patients receiving the home therapy report less fatigue, improved appetite and better skin color, but no large-scale studies have been done to determine intensive treatment's long-term health effects.
The National Institutes of Health is planning a study, but the results won't be known until 2008. Meanwhile, there are growing waiting lists at the few centers that offer the intensive treatment.
Source: Peter Landers, "Filtering Process: Longer Dialysis Raises Hopes, but Poses Dilemma; Who Gets Costly Treatment? Personality, Persistence and Housekeeping Count," Wall Street Journal, October 2, 2003.
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