More than 400,000 people in the United States are on dialysis at a cost of about $77,000 per patient and taxpayer cost of more than $20 billion a year. While the costs are among the highest in the world, the death rate is among the worst. One in four of the 100,000 patients who start the process every year in the U.S. will die within 12 months.
The payments are covered almost entirely by Medicare. Congress changed the Social Security Act in 1972 so that virtually any patient diagnosed with kidney failure, regardless of age or income, could receive treatment. Forty years later the program is coming under fire and being accused of high costs, poor patient care, inadequate oversight and causing premature deaths for thousands of people.
A year-long investigative report said the United States has one of the industrialized world's highest mortality rates for dialysis care. Even taking into account differences in patient characteristics, the report suggests that if the U.S. system performed as well as Italy's, or France's, or Japan's, thousands fewer patients would die each year.
The report comes from ProPublica, an independent non-profit online newsroom, in partnership with Atlantic magazine. ProPublica reviewed thousands of inspection reports and interviewed more than 100 patients, advocates, doctors, policy makers, researchers and industry experts to understand the state of American dialysis.
ProPublica's report states:
• At clinics from coast to coast, patients commonly receive treatment in settings that are unsanitary and prone to perilous lapses in care.
• Regulators have few tools and little will to enforce quality standards.
• Industry consolidation has left patients with fewer choices of provider.
• The government has withheld critical data about clinics' performance from patients, the very people who need it most.
• Two corporate chains that dominate the dialysis-care system are consistently profitable, together making about $2 billion in operating profits a year.