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The US dialysis program -- How good and how bad?

Posted Nov 16 2010 2:50pm

A recent article in ProPublica by Robin Fields contains a number of strong criticisms of the US dialysis program for people with kidney disease. Here's an excerpt

Now, almost four decades later, a program once envisioned as a model for a national health care system has evolved into a hulking monster. Taxpayers spend more than $20 billion a year to care for those on dialysis -- about $77,000 per patient, more, by some accounts, than any other nation. Yet the United States continues to have one of the industrialized world's highest mortality rates for dialysis care. Even taking into account differences in patient characteristics, studies suggest that if our system performed as well as Italy's, or France's, or Japan's, thousands fewer patients would die each year.

NPR's Terry Gross recently interviewed both Robin Fields and Barry Straube, Chief Medical Officer for Medicare. The interviews are worth hearing or reading. Here's an excerpt from Dr. Straube's interview

I believe that Robin's article, although pointing up some very important issues that this agency and the Department of Health and Human Services is aware of and trying its best to fix, that it overstates significantly the degree of the problem out in the real world. It makes it sound like any dialysis unit that a patient would walk into is subject to these problems and that's simply not true. The vast, vast majority of the units are not as described in the several examples, which are completely true examples but not illustrative of most dialysis units.

I think my main quibble with the article is that it sounds as though one would not want to have dialysis in the United States. This is a life-saving treatment that the vast majority of people are being treated very well in very clean facilities that hopefully make very few mistakes. And the examples there are not indicative of most dialysis units.

I conclude, having read and heard both, that there are elements of truth in the article about this kind of care and need for improvement. However, the magnitude of the problem seems to me to be less than reported. I welcome your thoughts.

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