Cost Considerations for the Management of End Stage Renal Disease in the United States

Abstract

Chronic renal failure from one of several causes will progress to end stage renal disease (ESRD) and death unless chronic dialysis or successful renal transplantation is provided. In 1972 chronic dialysis and/or renal transplantation when medically feasible were made available to all patients with ESRD in the United States through Medicare, the federal health insurance program that covers almost all older United States citizens. Under Public Law 92-603 any patient with ESRD requiring dialysis for over three months was declared eligible for Medicare which paid 80% of all chronic dialysis and renal transplantation cost including physician fees and hospitalization but not including medications, transportation for dialysis, or reimbursement for time lost from work(1). Initially, dialysis units opened in teaching hospitals and large clinics limiting the availability of dialysis to all ESRD patients in the United States. With the limited availability of dialysis, selection was made by committees within these centers using a variety of criteria.