The organization and financing of kidney dialysis and transplant care in the United States of America.
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.
Hirth
Richard A
RA
Health Management and Policy, University of Michigan School of Public Health, 109 S Observatory, Ann Arbor, MI 48109-2029, USA. rhirth@umich.edu
D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D016030:Kidney Transplantation / Q000191:economics*; D006278:Medicare / Q000191:economics / Q000458:organization & administration*; D012052:Reimbursement, Incentive / Q000458:organization & administration; D006435:Renal Dialysis / Q000191:economics*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology