title: Survey of hidden costs of dialysis in Italian for-profit and not-for-profit centers.
abstract: BACKGROUND
  Chronic dialysis exposes patients to several procedures that may influence lifestyle and quality of life. These hidden costs, however, have never been evaluated.
  
  
  OBJECTIVE
  To compare the costs related to diagnostic and therapeutic procedures between not-for-profit (nFP) and for-profit (FP) dialysis care systems, we mailed to Italian nephrology units a questionnaire on modalities of medical prescriptions and reservations, waiting time for tests and modalities of drugs distribution.
  
  
  RESULTS
  247 centers (42%) replied to the questionnaire: 177 nFP (72%) and 70 FP (28%). The response rate was 54% of nFP and 26% of FP centers. All centers provided hemodialysis (in satellite units, 42% nFP and 14% FP, p<0.001; at home, 23% nFP and 1% FP, p<0.001). Peritoneal dialysis was offered by 60% nFP and 6% FP (p<0.001). Centers provided dialysis care for 15,294 patients, 85% in nFP and 15% in FP. At least 1 general practitioner prescription for dialysis, diagnostic tests, specialist consultations and drugs, was requested to patients in 50% of nFP and 95% of FP centers (p<0.001). Reservations for tests and specialist visits were made by patients in 6% of nFP and 20% of FP centers (p<0.001). In nFP and FP centers, waiting time for tests was 2 vs. 4 days for lung x-ray (p<0.01), 7 vs. 11 days for gastroscopy (p<0.05) and 14 vs. 13 days for echocardiography (NS). Erythropoietin, phosphate binders and nutritional supplements, were supplied by patients in 7%, 46% and 37% of nFP centers, and 86%, 86% and 90% of FP centers (p<0.001).
  
  
  CONCLUSIONS
  The dialysis care system charges patients a high hidden cost, represented by procedures related to dialysis. Higher costs and reduced choice of treatment modalities may characterize the for-profit dialysis system.
authors.affiliation: Nephrology Division, "A. Landolfi" Hospital, Solofra - Italy. vincenzo.bellizzi@tin.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bellizzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Perrone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Terracciano
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cucciniello
authors.forename: Giovanna
authors.initials: G
authors.lastname: Stanzione
authors.forename: Pierluigi
authors.initials: P
authors.lastname: D'Angiò
authors.forename: Luca
authors.initials: L
authors.lastname: De Nicola
authors.forename: Biagio
authors.initials: B
authors.lastname: Di Iorio
mesh_terms: D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys / Q000379:methods*; D006436:Hemodialysis Units, Hospital / Q000191:economics*; D006801:Humans; D007558:Italy; D006435:Renal Dialysis / Q000191:economics*; D011795:Surveys and Questionnaires