HEALTH SERVICE USE, EXPENDITURES AND TRENDS IN PAYMENTS IN U.S. ADULTS WITH END-STAGE RENAL DISEASE: A NATIONAL STUDY
Methods: This was a cross-sectional study of ESRD adults and non-ESRD adults using a nationally representative Medical Expenditure Panel Survey. Data were pooled for years 2002 to 2010. Survey weights were used to generate mean estimates of office based visits and outpatient provider visits in those with a renal transplant, or dialysis, and among non-ESRD controls. Mean expenditures for each health service use category and total expenditures for all care were estimated independently by separate generalized gamma models with a log link function and adjusted by socioeconomic and demographic variables. Mean overall payments by public, private and self over the nine-year study period and trends in public and private payments were assessed between years 2002-2004 and 2008-2010.
Results: The weighed study sample comprised of 170,104 ESRD cases and 217 million non-ESRD controls. Of the weighted ESRD cases, 17% were recipients of a kidney transplant and 43% were on dialysis. The mean annual visits per person (PP) in the ESRD population, kidney transplant subpopulation, dialysis subpopulation, and the non-ESRD population were 21, 16, 24, and 6 respectively for the office based setting; in comparison, the mean annual visits PP were 7, 1, 9, and 0.6 for the outpatient setting. The associated adjusted mean expenditures PP among the ESRD population, kidney transplant subpopulation, dialysis subpopulation, and the non-ESRD population were $6126, $3745, $7369 and $668 for office based care; while mean expenses PP were $7838, $3559, $11307 and $443 for outpatient care. Mean annual total expenditures PP for all health care were $58594 for the ESRD population, $32581 for the kidney transplant subpopulation, $80795 for the dialysis subpopulation and $4591 for the non-ESRD population. Medicare paid $7194 vs. $37837 on average annually in kidney transplant or dialysis care. Private insurance paid $15991 vs. $22173 on average annually to care for renal transplant recipients or dialysis patients. The mean annual Medicare payments PP reduced by $3699 for kidney transplant care and $3844 for dialysis care during years 2002-2004 and 2008-2010. In contrast, the mean annual payments PP by private insurance reduced by $2764 for renal transplants care and increased by $24464 for dialysis care during years 2002-2004 and 2008-2010.
Conclusion and Policy Implications: ESRD remains a costly medical condition with high health care use. Although there is a downward trend in the fee-for service Medicare reimbursement for dialysis care, its cost burden is increasing in private payers. Better coordination of private and public plans is needed for ESRD cost control. The findings are particularly important in the light of high 20% mortality annually for dialysis patients in the U.S. and if the government’s imminent plans to cut the dialysis treatment reimbursement by 9.4% are implemented in 2014.