Abstract
In the United States, end-stage renal disease (ESRD) patients are primarily insured by the publicly funded Medicare program. Compared to other countries in the International Study of Health Care Organization and Financing (ISHCOF), the United States has the highest health care expenditures for the general population and among ESRD patients. However, because the Medicare program is more influential in the market for ESRD-related services than for other medical services, ESRD price controls have been relatively stringent. Nonetheless, ESRD costs have grown substantially through increases in prevalence and use of ancillary services. Treatment costs are also controlled by the relatively high rate of transplantation. Proposed reforms include bundling more services into a prospective payment system, developing case-mix adjustments, and financially rewarding providers for quality.
Similar content being viewed by others
References
Bragg-Gresham, J. L., Greenwood, R., Akizawa, T., Kurokawa, K., Bailie, G. R., Gillespie, B. W., Keen, M. L., & Young, E. W. (2003). Significant variation exists among the number of medications prescribed for hemodialysis patients across countries: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Journal of the American Society of Nephrology, 14, 833A.
Centers for Medicare & Medicaid Services (CMS). (2003). Program Memorandum Intermediaries/Carriers, Transmittal AB-03-001.
Centers for Medicare & Medicaid Services (CMS). (2004). 2004 annual report: ESRD clinical performance measures project. Baltimore, MD: Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of Clinical Standards and Quality.
Centers for Medicare & Medicaid Services (CMS). (2005). National Health Expenditure Data. Table 1: National Health Expenditures Aggregate, Per Capita Amounts, Percent Distribution, and Average Annual Percent Growth, by Source of Funds: Selected Calendar Years 1960–2005. Retrieved February 9, 2007, from http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf.
Dor, A., Pauly, M.V., Eichleay, M.A., & Held, P.J. (2007). End-stage renal disease and economic incentives: The International Study of Health Care Organization and Financing (ISHCOF). International Journal of Health Financing and Economics, DOI: 10.1007/s10754-007-9024-9
Dykstra D.M., Beronja N., Menges J., Gaylin D.S., Oppenheimer C.C., Shapiro J.R., Wolfe R.A., Rubin R.J., Held P.J. (2003). ESRD managed care demonstration: financial implications. Health Care Financing Review 24(4): 59–75
Hirth R.A., Held P.J., Orzol S.M. , Dor A. (1999). Practice patterns, case mix, Medicare payment policy, and dialysis facility costs. Health Services Research 33(6): 1567–1592
Hirth R.A., Chernew M.E., Orzol S.M. (2000). Ownership, competition, and adoption of new technologies and cost-saving practices in a fixed price environment. Inquiry 37: 282–294
Hirth R.A., Roys E.C., Wheeler J.R.C., Messana J.M., Turenne M.N., Saran R., Pozniak A.S., Wolfe R.A. (2005). Economic impact of case-mix adjusting the dialysis composite rate. Journal of the American Society of Nephrology, 16(5): 1172–1176
Leggat J.E., Orzol S.M., Hulbert-Shearon T.E., Golper T.A., Jones C.A., Held P.J., Port F.K. (1998). Noncompliance in hemodialysis: predictors and survival analysis. American Journal of Kidney Diseases 32(1): 139–145
Medical Group Management Association. (2003). Physician compensation and production survey. Englewood, CO: Medical Group Management Association.
Medicare. (2007). Dialysis facility compare. Retrieved April 13, 2007, at http://www.medicare.gov/Dialysis/Include/DataSection/Questions/SearchCriteria.asp.
MedPAC (2003). Assessing payment adequacy and updating payments for outpatient dialysis services. In Report to the congress: Medicare payment policy. Washington, D C: U.S. Department of Health and Human Services.
MedPAC. (2006). Outpatient dialysis services payment system. Washington, D C: U.S. Department of Health and Human Services.
Nissenson A.R., Rettig R.A. (1999). Medicare’s end-stage renal disease program: current status and future prospects. Health Affairs 18(1): 161–179
Norris K.C., Agodoa L.Y. (2002). Race and kidney disease: the scope of the problem. Journal of the National Medical Association 94(8):1–6
Osinski M., Wish J. (2005). Physician workforce: Coming up short. Nephrology News and Issues 19(4): 58–67
Pisoni R.L., Young E.W., Dykstra D.M., Greenwood R.N., Hecking E., Gillespie B., Wolfe R.A., Goodkin D. A., Held P.J. (2002) Vascular access use in Europe and the United States: Results from the DOPPS. Kidney International 61(1): 305–316
U.S. Renal Data System (USRDS). (2002). Annual Data Report: Atlas of end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.
U.S. Renal Data System (USRDS). (2003). Annual Data Report: Atlas of end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.
U.S. Renal Data System (USRDS). (2004). Annual Data Report: Atlas of end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.
U.S. Renal Data System (USRDS) (2005). Annual Data Report: Atlas of end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.
Wheeler J.R.C., Messana J.M., Turenne M.N., Hirth R.A., Pozniak A.S., Pan Q., Chuang C.C., Slish K., Tedeschi P., Roys E.C., Wolfe R.A. (2006). Understanding the basic case-mix adjustment for the composite rate. American Journal of Kidney Diseases 47(4): 666–671
Wolfe R.A., Ashby V.B., Milford E.L., Ojo A.O., Ettenger R.E., Agodoa L.Y., Held P.J., Port F.K. (1999). Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. New England Journal of Medicine 341(23): 1725–1730
World Health Organization (WHO). (2005). World Health Statistics 2005. Retrieved July 18, 2005, at http://www.who.int/healthinfo/statistics/en/index.html.
Young, E. W., Bodfish, L. J., Mapes, D. L., Mendelssohn, D. C., Kurokawa, K., Fukuhara, S., Pauly, M., Chen, K., Held, P. J., & Pifer, T. B. (2003). Insurance status and patient out-of-pocket costs for medications and dialysis treatments: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Journal of the American Society of Nephrology, 14, 256A.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hirth, R.A. The organization and financing of kidney dialysis and transplant care in the United States of America. Int J Health Care Finance Econ 7, 301–318 (2007). https://doi.org/10.1007/s10754-007-9019-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10754-007-9019-6