Wednesday, August 27, 2008


Anyone with end stage renal disease qualifies them for Medicare coverage. Currently this amounts to about 11 million patients in the US, with over 350,000 of them on dialysis - so about 2% of Medicare patients are on dialysis. For one patient, for one year, Medicare pays $67,000 for dialysis totally over $20 billion per year for dialysis, which takes up close to 10% of their budget. This means that 2% of Medicare patients take up close to 10% of the Medicare budget! And the numbers are only increasing.

I find this disturbing for a few reasons. For one, patients on dialysis are generally relatively sick. The 5-year mortality rate for patients on dialysis is 60%. That means that even with dialysis, a very expensive intervention, 6 out of every 10 patients on dialysis still die within 5 years.

Secondly, it's ethically questionable to spend so much money on a relatively small number of people. With a limited budget, the money could be used in countless other ways to prolong the lives or improve the health of a greater number of patients. Given the fact that 60% of patients still die within 5 years of starting dialysis, the cost-effectiveness of this intervention seems very high.

Finally, irrespective of ethics or efficacy of the treatment, can the U.S. afford this at this time? With rising rates of kidney failure and more and more patients needing dialysis, it may not be a possibility for the United States to continue paying for dialysis for all patients in the future. Not really a question I'm qualified to answer.

So what's the answer? Once someone has Medicare and is on dialysis, it's definitely ethically questionable to take away that treatment and send them on their way towards death! I don't have any great solutions, but perhaps the government will eventually have to stop providing payments for dialysis, with some sort of grandfather clause for those already on dialysis.

Of course, I'm sure if someone I cared about, or I myself, were on dialysis, my opinions and thoughts would be completely different.


mikefrandsen said...

What you fail to realize is that many people are on dialysis for a year or two, then get a successful transplant, and then live another 30 years. But this is just indicative of our country's attitude - only the healthy and the wealthy - not the poor and the sick - get a fair chance at health insurance, so the poor and the sick die at a much higher rate. Of course, you can save a lot of money by not treating them.

JoJoJangJang said...

You're right - I hadn't considered that possibility. But I also think this country actually does much better than a lot of other countries that provide -no- or inadequate health care for a the great percentage of their population. Also, when you think of how many people could get even just basic coverage by cutting out something costly that a smaller percentage of the people benefit from, I would choose benefiting the larger amount of people almost every time.