The Organization of Medical Care: Lessons From the Medicare End Stage Renal Disease Program
Levinsky, Norman G.
New England Journal of Medicine. 1993 Nov 4; 329(19): 1395-1399.
...The participants in the debate about the reorganization of U.S. health care have taken little notice of the experience with existing health care systems organized by our government. The Medicare program that provides treatment for patients with end-stage renal disease (ESRD) is 20 years old; recently, it has been the subject of extensive review and analysis. Over the past 20 years, the Medicare End Stage Renal Disease Program has demonstrated many of the virtues and problems of modern high-technology medicine. Hundreds of thousands of Americans have enjoyed extra years of good-quality life because the program lowered financial barriers to lifesaving technology. However, the quality of life achieved by some patients on dialysis has been suboptimal, and costs have escalated far beyond the original expectations. The lessons of the End Stage Renal Disease Program have not been applied to the current debate about health care reform. My purpose is to review the program from this perspective. The dialysis machine has been described as "a metaphor for modern technological medicine"; the implications of this metaphor for health policy deserve careful scrutiny.
Age Factors; Biomedical Technologies; Disease; Economics; Federal Government; Females; Government; Government Financing; Health; Health Care; Health Care Delivery; Health Care Reform; International Aspects; Justice; Kidney Diseases; Kidneys; Life; Males; Medicine; Metaphor; Minority Groups; Organ Transplantation; Patients; Physicians; Politics; Public Policy; Quality of Health Care; Quality of Life; Remuneration; Renal Dialysis; Resource Allocation; Review; Scarcity; Selection for Treatment; Technology; Transplantation; Virtues;
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Levinsky, Norman G.; Rettig, Richard A. (1991-04-18)Since End-Stage Renal Disease (ESRD) patients became entitled to Medicare benefits in 1972, the program has extended treatment access to many thousands of kidney failure victims. Gradually increasing expenditures have led ...