National Dialysis Treatment Program Under Fire; Criticized As Too Costly, Risky

Kidney dialysis treatment in the U.S. is costly and has high death rates, but it doesn't have to be that way, USA Today reports: "The vast majority of the more than 350,000 Americans on dialysis are treated in centers, where three treatments a week, three or four hours each, is the norm — not because it's optimal but because that's the way it has been done for nearly four decades. A growing body of evidence suggests that longer and/or more frequent dialysis treatments, either at home or in a dialysis center, are far superior to the status quo. Although the USA spends more per dialysis patient than other countries, that does not result in higher survival rates or even, many argue, a better quality of life."

Many experts blame Medicare's End Stage Renal Disease Program for maintaining this approach, rather than updating it. "Launched in 1973, it's the only federal program that entitles people of all ages to health-care coverage on the basis of a single diagnosis: chronic kidney failure. By paying for lifesaving care for hundreds of thousands of Americans, the program is a testament to what health insurance reform might achieve if Congress were to adopt it. But it also may be a cautionary tale: Its cost has far exceeded initial projections, and some doctors and other analysts question whether Medicare get its money's worth and whether patients get the best treatment. ... In 2007, Medicare spent $8.6 billion on the treatment and medications of dialysis patients ... Despite the costs, a substantial proportion of dialysis patients die every year" (Rubin, 8/23).

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