Kidney failure and the federal government / Committee for the Study of the Medicare End-Stage Renal Disease Program, Division of Health Care Services, Institute of Medicine ; Richard A. Rettig and Norman G. Levinsky, editors.

Includes bibliographical references and index.

Overview -- Summary -- Introduction -- Patients and providers -- Perspectives of ESRD patients -- Ethical issues -- The patient population -- The ESRD patient population: special groups -- Structure of the provider community -- Access -- Access problems of ESRD patients -- Access to kidney transplantation -- Reimbursement and quality -- Medicare ESRD payment policy -- Reimbursement effects on quality -- Outpatient dialysis reimbursement issues -- Quality assessment and assurance -- Data and research -- Data systems -- Research needs.

Since 1972, many victims of endstage renal disease (ESRD) have received treatment under a unique Medicare entitlement. This book presents a comprehensive analysis of the federal ESRD program: who uses it, how well it functions, and what improvements are needed. The book includes recommendations on patient eligibility, reimbursement, quality assessment, medical ethics, and research needs. Kidney Failure and the Federal Government offers a wealth of information on these and other topics: The ESRD patient population ; Dialysis and transplantation providers ; Issues of patient access and availability of treatment ; Ethical issues related to treatment initiation and termination ; Payment policies and their relationship to quality of care. This book will have a major impact on the future of the ESRD program and will be of interest to health policymakers, nephrologists and other individual providers, treatment site administrators, and researchers.

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English.

""Kidney Failure and the Federal Government""; ""Copyright""; ""Acknowledgments""; ""Contents""; ""PART I Overview""; ""Summary""; ""THE CONGRESSIONAL CHARGE TO THE INSTITUTE OF MEDICINE""; ""BASIC ASSUMPTIONS""; ""ESRD PATIENTS AND THEIR TREATMENT""; ""ACCESS""; ""ETHICS""; ""THE PROVIDER COMMUNITY""; ""REIMBURSEMENT AND QUALITY""; ""Reimbursement Effects on Quality""; ""Outpatient Dialysis Reimbursement Issues""; ""Covered Services""; ""Rate-Setting and Payment Policy""; ""QUALITY ASSESSMENT AND ASSURANCE""; ""DATA SYSTEMS""; ""RESEARCH""; ""NOTES""; ""REFERENCES""; ""1 Introduction""

""THE CONGRESSIONAL CHARGE""""BASIC ASSUMPTIONS""; ""CONTEXT OF THIS STUDY""; ""STUDY METHODS""; ""THE ESRD PATIENT POPULATION""; ""NATIONAL EXPENDITURES FOR ESRD""; ""ORGANIZATION OF THE REPORT""; ""NOTES""; ""REFERENCES""; ""PART II Patients and Providers""; ""2 Perspectives of ESRD Patients""; ""EXPERIENCES WITH RENAL FAILURE""; ""Patient Relationships with Physicians and Staff""; ""Patient Education""; ""Patient-Related Services""; ""Effect of Erythropoietin""; ""ECONOMIC EFFECTS OF KIDNEY FAILURE""; ""CONCLUSIONS""; ""NOTE""; ""REFERENCE""; ""3 Ethical Issues""

""PATIENT ACCEPTANCE CRITERIA""""WITHDRAWAL FROM TREATMENT""; ""Guidelines""; ""Advance Directives""; ""TREATING THE PROBLEM PATIENT""; ""CONCLUSIONS AND RECOMMENDATIONS.""; ""NOTES""; ""REFERENCES""; ""4 The Patient Population""; ""INCIDENCE AND PREVALENCE""; ""COMPOSITION OF THE ESRD POPULATION""; ""MORTALITY ISSUES""; ""Unadjusted Mortality""; ""Adjusted Mortality""; ""Subgroup Mortality""; ""STATE AND REGIONAL MORTALITY DATA""; ""CROSS-NATIONAL MORTALITY DATA""; ""PROJECTIONS TO THE YEAR 20006""; ""NOTES""; ""REFERENCES""; ""5 The ESRD Patient Population: Special Groups""

""PEDIATRIC PATIENTS""""ELDERLY ESRD PATIENTS""; ""DIABETIC PATIENTS""; ""HYPERTENSIVE PATIENTS""; ""Hypertension in the United States""; ""Relationship Between Hypertension and Hypertensive ESRD""; ""Epidemiology of ESRD Attributed to Hypertension""; ""Intervention""; ""MINORITY PATIENTS""; ""CONCLUSION""; ""NOTES""; ""REFERENCES""; ""6 Structure of the Provider Community""; ""OVERVIEW""; ""Outpatient Dialysis Facilities""; ""Kidney Transplant Centers""; ""Pediatric Facilities""; ""CHANGING STRUCTURE OF THE OUTPATIENT DIALYSIS COMMUNITY""; ""Hospital-Based Versus Independent Providers9""

""Hospital-Based Providers""""Patients""; ""Independent Providers""; ""Outpatient Dialysis Facilities""; ""Not-For-Profit Versus For-Profit Providers11""; ""Not-For-Profit Providers""; ""For-Profit Providers""; ""Size of Outpatient Dialysis Facilities12""; ""Facility Ownership""; ""CONCLUSIONS""; ""NOTES""; ""REFERENCES""; ""PART III Access""; ""7 Access Problems of ESRD Patients""; ""ESRD PATIENTS NOT ELIGIBLE FOR MEDICARE""; ""Who Are the Reported Noneligibles?""; ""Magnitude of the Problem""; ""Geographic Variations""; ""Payment Sources""; ""State Medicaid Programs""

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