Implications for Health Care Policy

Abstract

Before 1973, selection of patients with end-stage renal disease (ESRD) for treatment was necessary because of inadequate medical and financial resources. Patients were selected based partly on social worth rather than medical suitability. In 1973 ESRD patients became eligible for Medicare benefits, eliminating the financial barrier to treatment. Using data from two national surveys of hemodialysis patients in 1967 and 1978, two social and demographic profiles of patients illustrate the effect of extension of Medicare benefits on composition of the dialysis patient population. These data indicate that problems of patient selection have been resolved, and ESRD patients now have equal access to medical care. Nevertheless, there is growing pressure for cost efficiency for the ESRD program in the tightening economic climate. This may lead again to some form of restriction for future access to dialysis therapy. (JAMA1981;245:487-491)