Economics of End Stage Renal Disease
The Economics of End-Stage Renal Disease Karen Period Walden University With the amount of people needing healthcare on the rise, an aging population, and more people with chronic illnesses it is no surprise our healthcare costs are going up. Healthcare spending is increasing at a fast rate with projections approaching $3. 5 trillion in 2013 (Makes, 2005). “Chronic kidney disease, or CD, impacts the lives of more than 26 million patients in the United States with millions of others at an increased risk of developing the disease” (Sullivan, 2010, p. 45).
End stage renal disease (USER) has significant health consequences and high-cost treatment due to the seriousness of the illness. CD and USER are very costly to treat, with nearly 25 percent of the Medicare budget being used to treat people with these diseases (“CD,” 2013). Medicare is one of the big players of reimbursement for those suffering from USER. “Administered by the federal government, Medicare originally targeted people 65 and over, but was quickly expanded to cover people with disabilities and severe kidney disease” (Cover & Knickknack, 2011, p. 4). Reimbursement for those with USER receiving any form of dialysis; hemophilia’s (HAD), peritoneal dialysis (PDP), continuous ambulatory peritoneal dialysis (CAP)
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The program instituted for USER by the government, paid for by tax dollars, has been scrutinized due to its growing mortality rates and gig economic burden; but on the other hand, applauded for its success. The Reimbursement for HAD is based on a thrice a week structure. PDP is performed every day and reimbursement for this treatment is identical to HAD; the same amount of money is paid for three treatment week even though PDP is a seven day a week therapy (Sullivan, 2010). For both PDP and HAD, reimbursement is based on a basic treatment with further payments being made for testing and supplemental drugs (Sullivan, 2010).
HAD is more expensive than PDP, and the difference seems to be in hose additional drugs that are needed for treatment. The cost of treating those with USER will continue to rise due to new technology, increased incidence of diabetes and hypertension, and even an increase in those surviving while on dialysis. The governmental cost must be decreased, but the financial burden placed on Medicare from the renal community is huge; using up 6% of the budget for less than 1% of the Medicare population (Sullivan, 2010). As of 2011, USER patients will be entering a payment structure which will bundle the rates. The reasoning behind this change is keel to control costs associated with additional necessary drugs while creating a high quality environment thorough quality measures in outcomes to ensure that care isn’t being reduced under bundling to secure higher profitability’ (Sullivan, 2010, p. Economics of End Stage Renal Disease By skippering approximately 16,000 patients, but the current Medicare payment is $20. 3 billion for 437,334 patients” (Sullivan, 2010, p. 47). The main concept with dialysis was it would serve as a model for health care in the United States, but is not an accurate picture of he everyday population.
Dialysis clinics/chains, such as Freshness Medical Care and Davit, require a lot of structure and administrate support. With costs being cut, more patients are being added, and the supportive links are being eliminated. “By controlling larger shares of the market, dialysis chains can leverage payments from commercial insurance providers making up more than the difference from the Medicare and Medicaid shortfall” (Sullivan, 2010, p. 48). Several options are available for those suffering from USER – renal transplant, PDP, HAD or no dialysis at all.
Transplantation is not only the ideal treatment, but is the most cost effective and best option for a patient’s quality of life (Sullivan, 2010). HAD is primarily done in outpatient clinics and some hospitals, with most nephritis’s choosing this treatment for their patients. HAD is usually done three times a week for 3-5 hours at a time. HAD requires vascular access, so patients are at risk for infection, clots and could require hospitalizing to ensure proper blood flow for dialysis. PDP uses a catheter that is implanted into the lower abdomen to utilize the peritoneal cavity to infuse the alkalis fluid (Sullivan, 2010).
CAP is a form of PDP that has multiple exchanges throughout the day, while CAP utilizes a cycles machine that is used at night. CAP is the preferred PDP prescription due to its technological advanced cycles. PDP can be done at home so transportation to and from a clinic is not required and is more flexible for the patient. Finding a treatment that is right for you which is both cost and clinically effective, and of high quality, would help with the increasing cost of USER. Ethical issues relating to therapy are drawing rising interest within the renal immunity.
If treatment is not available when it is needed due to cost or access; the quality of the healthcare can be compromised. Many nephritis’s in the United States and Canada have questioned why dialysis treatment is more expensive in the United States (Dash & Mailbox, 2013). “The prevalence and incidence of USER have increased in all high-income countries for several reasons, including the aging of the population, increasing diabetes rates, improved survival from heart disease, and greater acceptance to dialysis therapy'(Door, Paula, Cochleae, & Held, 2007, p. ).
The choice of treatment that a patient makes will vary from individual to individual, with some treatments not being an option, or available for each person (Bessel & Watson, 2008). Some patients may even opt for no treatment at all. PDP seems to be easier and more cost effective than HAD so why do we have more patients in an HAD setting? The profit of HAD is higher for physicians, and many nephritis’s are being motivated to invest in HAD to drive up the volume and have more leverage in their investment (Sullivan, 2010). How is that fair too patient who Just wants the easiest and most cost effective treatment?