Federal Kidney Program: Unintended Consequences
When Congress established the entitlement to pay for kidney patients in October 1972 … it … was expected … that fewer than 40 patients per million would need dialysis, and that most of those patients would be healthy — except for their failed kidneys — and under age 54.
Now more than 400 people per million start dialysis each year. More than a third of the patients are 65 or older, and they account for about 42 percent of the costs. People over 75 make up the fastest-growing group of dialysis patients. And most elderly dialysis patients have other serious diseases like diabetes, heart failure, stroke and even advanced dementia. One-third of them have four or more chronic conditions.
Full article on the issues stemming from the federal kidney program.
Another consequence of the program that made End Stage Renal Disease an entitlement was to discourage a market from developing that would have been made dialysis more efficient and convenient. People often go to dialysis centers two or three times a week where they sit around half a day or more. The alternative is small, portable machines that could be administered while patients sleep at home. Government reimbursements for one type of care made the development of alternative types of care a hard sell since one was free while the other was not covered.
Also, part of the issue nowadays is education and training. The brick and mortar dialysis centers are already established; whereas to train seniors to administer their own dialysis machines involves resources that don’t currently exist (people who can train, monitor and verify seniors are getting the care they need).
There is almost no chance of changes in the dialysis payment scheme. The dialysis companies are too big and have too many lobbyists to allow a decrease in coverage or meaningful innovation. If Congress had wanted to rein in spending, it should have thought about that in the 70’s when the program first started.
Come to think of it, reining in spending is probably much easier to do when you never fund a program in the first place.
My family faced this exact situation in October with my 94 year old great grandmother. We ended up choosing hospice care after some very frank conversations with the doctors . At the time, I was one of the very few who wanted to do dialysis. It is easy to say “what is the point with someone that age”, but it is different when it is your loved one. I am now happy with the decision that was made. The medical staff took the time to educate us on our options and that made all the difference in the world.
I cannot believe that you would try to consider a dollar value instead of a human life. So heartless.
Yeah ok Alfie. They why don’t you pay for it?
And if you can’t/won’t or don’t, we should ask you why you’re placing a dollar value higher than a human life. So heartless.
Ditto, Devon Herrick: Kidney dialysis is difficult enough, but it’s also just plain inconvenient because patients have had to travel to dialysis centers at inconvenient times. Although it’s possible to dialyze at home, 92% of patients are “treated in centers . . . not because it’s optimal but because that is the way it has been done for nearly four decades.”
The U.S. government’s Medicare program is the monopoly health insurer for patients who need the treatment. That goes a long way to explain why the protocol is frozen in time. Can you think of any medical specialty — cardiology, psychiatry, orthopedic surgery, etc. — where you can describe what’s happening today as no different than four decades ago?
I wrote about this at some length at http://tinyurl.com/2deg3bp.
An opening salvo in the campaign to deny care to people based solely on their age. For dialysis, this is already in force at some surprisingly young ages in the UK and Europe.