Economics of End-Stage Renal Disease - Special Academic Support

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The major function of the kidneys is to excrete metabolic body waste. End-stage kidney disease care costs differ, but modality hemodialysis is the most expensive. According to a case study on end-stage renal disease, treatment options for the end-stage renal system includes hemodialysis, peritoneal dialysis, and kidney transplant. Treatment of end-stage renal system through peritoneal dialysis requires low investment but also has high variable costs.

Management of patients suffering from end-stage renal disease through hemodialysis and peritoneal dialysis is more costly than doing kidney transplants of the patients. With these considerations, annual care of end-stage kidney disease is very expensive (Ashton & Marshall, 2007). Funding of end-stage renal disease affects the countrys economy since it is derived from the countrys general taxation. According to an economic end, renal disease case study, cost for the end-stage renal disease treatment program increased to more than $18 billion in 2005, consuming a higher and higher percentage of the budget ($500 billion total budget for federal Medicare and Medicaid expenditures) while covering fewer and fewer of the Medicare beneficiary population

For instance, higher-income earners have high rates of personal income tax, and therefore they pay more annual income tax. Those earning low income are exempted from paying such taxation. The biggest component of private sector expenditure relates to private health care insurance premiums. Private health care insurance can be bought to cover the concept of care that is not wholly covered by public insurance. Examples are outpatient dentistry, pharmaceuticals, physiotherapy, and some amenities during a hospital stay. Hemodialysis is an expensive procedure. To provide treatment in an outpatient clinic requires high initial capital investment and a high capacity and volume of patients to break even or be profitable. Peritoneal dialysis requires low investment but also has high variable costs. The government reimbursement rate for dialysis has remained unchanged since 1973, which has resulted in cost-shifting (Bargman et al, 1999).

Some end-stage kidney disease drugs provided to patients without the need for a third party or government-sponsored insurance affect the economy. Intravenous vitamin D and erythropoietin, used in conservative management of the end-stage renal disease are bought by the patient at a pharmacy at a high price, and then they are taken to the dialysis center for injection.

Patients are required to pay more money for end-stage renal disease. Economics of end-stage renal disease case study indicates that funding from the North American government budget is used for reimbursement of provided bundled rates for treatments (example of a bundle: dialysis, EPO, Vitamin D, disease management). Iron is used less frequently at least for hemodialysis patients. It requires a copayment because it is dispensed by pharmacies

Protocols are designed to improve compliance to these guidelines and promote appropriate treatment in various areas including anemia management, utilization of mineral metabolism, and monitoring to prevent complications, which can increase the cost of treatment due to complications.

Funding for online access monitoring, vascular and angiography access usually come directly out of program or hospital budgets, with no charge to patients. Care for end-stage kidney disease is non-profitable. Low investment but high variable cost compromise private facilities and physician practice (Nicholson & Roderick, 2007).

Government planners see patients as a source of excessive costs, which serve as a reason for delayed dialysis expansion to keep incidence rates from increasing. If funding for end-stage renal disease falls to levels that are below treatment costs, the quality of care is altered. Tracking of quality care indicators at the facilities, provincial, and national categories is important for the economy. The government should offer education to the population concerning ways of preventing end-stage renal disease. This is a primary care measure in disease prevention. (Lee, Manns, Taubs, Ghali, Dean& Johnson, 2002)

The average hospitalization per hospital admission is approximately 18 days. Admission is required to handle an access-related complication, a factor contributing to lengthy hospital stays, which affects the economy. Patients donating or receiving an organ do not require sharing in the cost of the transplantation procedure. In addition, transplant patients receive anti-rejection drugs at no cost throughout the life of the transplanted organ. Other non-immunosuppressive drugs are covered via government-sponsored insurance programs causing some effect on the economy. Surgical transplantation patients spend on average 14 days in the hospital for surgery. Transplantation probability increases with the individuals income and education levels. The most educated patients and families are considered a more living-related kidney donation. Hemodialysis costs affect the economy. It entails; hemodialysis for both in-center and satellite units. The estimated cost for maintaining hemodialysis is also high (Nicholson & Roderick, 2007).

Dialysis physician payments are high. It includes calculations involving the amount of time they get treatment throughout the year to yield annual dialysis reimbursement for the physicians both in-center and satellite unit estimations. Hospitalization costs are high hence affecting the economy. This is due to the services and facilities offered, in addition to drugs offered including dialyzing in all types of facilities. Other factors affecting the economy due to costs incurred include emergency room visits, clinic visits, laboratory costs, day surgeries, and diagnostic imaging for diagnosis purposes. Transportation costs also have an effect especially for those patients who travel a long distance to seek medical attention like dialysis care. Costs for a kidney transplant are high for the various stages of transplantation. Patients receiving or donating an organ are not required to share in the cost of the transplantation procedure. All transplant patients receive anti-rejection drugs at free cost throughout the life of the transplanted organ (Churchill, Blake, Jindal, Toffelmire, & Goldstein, 1999). Other non-immunosuppressive medications are covered through government-sponsored insurance programs, and standard weighting hemodialysis expenditure (Ashton & Marshall, 2007).

When considering any potential differences in health outcomes, it is important to note that the funding structure for end-stage kidney disease care differs across the world. These are differences, which make it hard to make general conclusions about the effects of end-stage kidney disease funding on specific patient outcomes. However, crucial common economic factors do exist across the world, which may contribute to patient outcomes. In addition, remuneration for the provision of outpatient dialysis is not typically tied to a fixed dialysis fee as there is often room to fund extra services within programs, including night hemodialysis for selected patients, as well as new and ongoing quality improvement initiatives. It is possible that the structure and financing of the health care system is one of the factors that contribute to the relatively low prevalence of end-stage renal disease in some countries or high prevalence in others.

References

Ashton, T. & Marshall, M. (2007). The organization, and financing of dialysis and kidney transplantation services in New Zealand. International Journal of Health Care Finance and Economics, 7(4), 233-252.

Bargman, J. M., Bick, J., Cartier, P., Dasgupta, M. K., Fine, A., Lavoie, S. D. et al. (1999). Guidelines for adequacy and nutrition in peritoneal dialysis. Journal of the American Society of Nephrology, 10(13), 311-321.

Churchill, D. N., Blake, P. G., Jindal, K. K, Toffelmire, E. B., & Goldstein, M. B. (1999). Clinical practice guidelines for initiation of dialysis. Journal of the American Society of Nephrology, 10(13), 289-291.

Lee, H., Manns, B. J., Taub, K., Ghali, W., Dean, S. & Johnson, D. (2002). Cost analysis of ongoing care of patients with end-stage renal disease: The impact of dialysis modality and dialysis access. American Journal of Kidney Diseases, 40, 611622.

Nicholson, T. & Roderick, P. (2007). International Study of Health Care Organization and Financing of renal services in England and Wales. International Journal of Health Care Finance and Economics, 7(4), 283-299.

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