Death Rate Higher at For-Profit Dialysis Centers
By Merritt McKinney
NEW YORK, Nov 29 (Reuters Health) -- People who need dialysis because
their kidneys have failed are more likely to die, and less likely to
be put on a waiting list for a kidney transplant, if they receive care
at a for-profit dialysis center rather than at a not-for-profit facility,
according to results of a national study.
In the study of more than 3,500 people with kidney failure, those who
underwent dialysis at for-profit dialysis centers were about 20% more
likely to die during the study period than those treated at not-for-profit
centers. Patients at for-profit centers were also about 26% less likely
to be put on a waiting list for a kidney transplant, an operation that
can significantly improve quality of life, according to a team of researchers
led by Dr. Pushkal Garg of Harvard Medical School in Boston, Massachusetts.
The difference in death rates may stem in part from attempts by for-profit
facilities to cut costs, Garg and colleagues believe.
The amount paid per dialysis treatment by Medicare, which covers most
dialysis patients, has not increased since 1973, the investigators note
in The New England Journal of Medicine for November 25th. Therefore,
they speculate, for-profit centers may be more likely than not-for-profit
facilities to reduce costs by employing fewer staff members and using
Likewise, attention to the financial bottom line may account for the
lower referral rate for kidney transplants, according to the report.
Since dialysis patients are a steady source of revenue, for-profit centers
may be more reluctant than not-for-profit centers to put them on a kidney-transplant
waiting list, Garg's team suggests.
Despite the findings, the study "...says absolutely nothing about
the quality of care provided at any particular for-profit or not-for-profit
(center)," Garg told Reuters Health.
The study results represent an average of many different dialysis centers,
he pointed out. The researchers were not able to look at the results
of individual facilities.
Furthermore, Garg said, the results apply only to free-standing dialysis
centers, since the analysis did not include hospital-based dialysis programs.
People undergoing dialysis should not change their medical provider based
on this study, Garg said. "That would be the absolute wrong thing
for someone to do."
However, it is always a good idea to find out as much as possible before
choosing a dialysis center, he noted. Garg recommends talking to the
center's staff and patients, if possible, as well as checking to see
if the facility is clean.
The current study, as well as previous research, suggest that, even though
for-profit and not-for-profit dialysis centers face the same financial
constraints, "for-profit facilities respond differently from not-for-profit
facilities -- to the detriment of patient care," according to Dr.
Norman Levinsky of Boston University Medical Center.
In an editorial that accompanies the study, Levinsky calls for a review
of dialysis treatment in for-profit centers.
SOURCE: The New England Journal of Medicine 1999;341:1653-1660,