Unequal access to cadaveric kidney transplantation in California based on insurance status.
OBJECTIVE
To assess the impact of insurance status on access to kidney transplantation among California dialysis patients.


METHODS
California Medicare and Medicaid dialysis populations.


METHODS
All California ESRD dialysis patients under age 65 eligible for Medicare or Medicaid in 1991 (n = 9,102) took part in this cohort analytic study.


METHODS
Medicare and California Medicaid Program data were matched to the Organ Procurement and Transplantation Network Kidney Wait List files.


RESULTS
Only 31.4 percent of California Medicaid dialysis patients were placed on the kidney transplant waiting list compared to 38.8 percent and 45.0 percent of dually eligible Medicate/Medicaid and Medicare patients, respectively. Compared to the Medicaid population, Medicare enrollees were more likely to be placed on the kidney transplant waiting list (adjusted Relative Risk [RR] = 2.10, Confidence Interval [CI] 1.68, 2.62) as were dually eligible patients (RR = 1.54, CI 1.24, 1.91). Once on the waiting list, however, Medicare enrollment did not influence the adjusted median waiting time to acquire a first cadaveric transplant (p > .05).


CONCLUSIONS
California dialysis patients excluded from Medicare coverage, who are disproportionately minority, female, and poor, are much less likely to enter the U.S. transplant system. We hypothesize that patient concerns with potential subsequent loss of insurance coverage as well as cultural and educational barriers are possible explanatory factors. Once in the system, however, insurance status does not influence receipt of a cadaveric renal transplant.
Thamer
M
M
Medical Technology and Practice Patterns Institute, Bethesda, MD 20814, USA.
Henderson
S C
SC
Ray
N F
NF
Rinehart
C S
CS
Greer
J W
JW
Danovitch
G M
GM
D000293:Adolescent; D000328:Adult; D015982:Bias; D002102:Cadaver; D002140:California; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007182:Income; D019458:Insurance Coverage; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy; D016030:Kidney Transplantation / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D011203:Poverty; D006435:Renal Dialysis; D014481:United States; D014850:Waiting Lists