ESRD Treatment
ESRD Treatment
Major Reimbursement Mechanisms
In the article, Sullivan (2010) presents different reimbursement mechanisms for the treatment of end stage renal disease (ESRD) in the United States. The first reimbursement mechanism encompasses the hemodialysis treatment program. Through this mechanism, Medicare pays for the ESRD treatment services at a dialysis center or hospital (Sullivan, 2010). The provision of the hemodialysis treatment plan occurs three times in one week. In the United States, most ESRD patients are on this treatment plan. The hemodialysis treatment plan for end stage renal disease not only consumes a lot of time but also results into high costs for the taxpayer. However, this reimbursement is widely popular among most nephrologists in the country. The second reimbursement plan encompasses a home treatment plan for end stage renal disease. This treatment plan is referred to as peritoneal dialysis (PD).
Although this treatment program requires a lot of input from the patient, it results into minimal costs. However, only a small percentage of the ESRD patients are on the peritoneal dialysis program (Sullivan, 2010). The third reimbursement mechanism for ESRD treatment in the United States encompasses kidney transplantation. Essentially, kidney transplantation serves as the most effective treatment plan for end stage renal disease. However, the waiting list for kidney transplants in the United States keeps bulging every day.
According to Sullivan (2010), there are more than 80,000 Americans on the current waiting list. This implies that hemodialysis and peritoneal dialysis are the only alternatives for most ESRD patients. Although some companies develop artificial kidneys, the costs are too high for inclusion in a universal health care system. In essence, all reimbursement mechanisms for ESRD have advantages as well as shortcomings. It is thus a major challenge for Medicare to balance between accesses and costs (Sullivan, 2010).
Economics of Providing ESRD
Health care organizations in the United States face the challenge of balancing between the quality and costs of end stage renal disease treatment. For-profit organizations have the goal of maximizing profits. However, they have the responsibility of maintaining the highest standards of health care. The most effective treatment plan for end stage renal disease is quite expensive in comparison with other alternatives (Green, 2012).
The treatment program for end stage renal disease at a dialysis center is much expensive than the home treatment plan. However, the health care organization cannot maximize profits through the home-based reimbursement mechanism for end stage renal disease. Over the years, most health care organizations have been pushing for additional funding for the hemodialysis treatment program. Essentially, the end-result of this is more profits for the organization. On the other hand, this would continue to put the taxpayer under more pressure. The provision of the hemodialysis treatment plan occurs three times in a week (Chambers, 2010).
On the other hand, the peritoneal dialysis treatment plan is administered frequently throughout the week. However, Medicare allocates the same amount of money for both treatment plans. It is important to note that the dialysis market in the United States is more or less a duopoly. DaVita and Fresenius Medical Care are the two dominant forces in the United States’ market for dialysis services. This factor has been a contributor towards the escalating costs of ESRD treatment in the country. Even if these organizations charge higher costs, they still serve as the only alternatives (Kovner, 2011).
Patient Options and Potential Trade-Offs
Essentially, end stage renal disease patients have three treatment options. Among the three, kidney transplants serve as the most effective treatment option for ESRD patients. Although a transplant is not a cure, it serves as the most viable option. In terms of costs, transplantation might be cheap is there is a readily available donor (Green, 2012).
However, this is highly unlikely especially considering the long waiting list for kidney transplants. This means that the cost of kidney transplantation in the United States is extremely high for ESRD treatment. Additional drugs and constant checkups are also essential after the transplantation. The second option for ESRD patients involves the peritoneal dialysis treatment plan. Although this option is relatively inexpensive in relation to other alternatives, it is less effective. The third option for end stage renal disease patients is the hemodialysis treatment plan (Chambers, 2010).
In-center hemodialysis is more effective compared to the home-based hemodialysis. Both the peritoneal dialysis and hemodialysis treatment plans fall under Medicare’s reimbursement mechanisms. However, Medicare does not cover for the additional drugs for supplementing the dialysis treatment plans. Consequently, ESRD patients must pay for the additional costs. This helps in enhancing the quality of outcome for the various treatment plans for end stage renal disease (Morrison, 2010).
Ethical Implications
Numerous ethical issues emerge from the ESRD treatment options that are based on cost evaluation. The health or wellbeing of patients should override other factors in any treatment plan. Although some treatment plans result into minimal costs, they might not necessarily yield the best outcomes. Medicare’s fundamental principle stipulates that cost should not play a role in decision making process for the country’s health care system (Harris, 2011).
It is thus unethical to withhold funds for the reimbursement of ESRD treatment on the basis of high costs. On the other hand, the American economy is on a downward curve in terms of performance. The federal government is evidently short of funds to cater for all its operations. Such perspectives have had a negative effect on the budgetary allocation for Medicare. It is this difficult for Medicare to assume the critical role played by cost evaluation in decision making. According to Sullivan (2010), Medicare is currently paying over $20 billion on an annual basis for the various treatment programs for end stage renal disease. This amount of money is quite high considering that just about half a million patients benefit from the program. This figure constitutes less than 1% of the entire population of United States (Green, 2012).
This raises serious ethical questions about the economic viability of Medicare’s reimbursement for the treatment of end stage renal disease. Another ethical issue concerning cost evaluation is the improvement of patient’s well being. Patients suffering from end stage renal disease can barely live for more than three weeks without any form of treatment. If Medicare reduces the money spent on ESRD treatment, it will result into many deaths in the country (Morrison, 2010).
This is because more than 25million Americans are suffering from one or more forms of kidney complications. It is fundamentally unethical for Medicare to ignore the plight of such patients. The organizations providing dialysis and other types of ESRD treatments also pose some ethical questions. Whereas they seek to maximize profits, they should contribute towards the wellbeing of ESRD patients. It is thus unethical for the organizations to inflate the costs of ESRD treatment (Green, 2012).
References
Chambers, E. J. & Brown, E. (2010). Supportive care for the renal patient, Oxford:Oxford University Press
Green, M. A. & Rowell, J. C. (2012). Understanding health insurance: A guide to billing and reimbursement, Clifton Park, NY: Delmar
Harris, D. M. (2011). Ethics in health services and policy: A global approach, Hoboken,NJ: John Wiley & Sons
Kovner, A. R. & Knickman, J. R. (Eds.) (2011). Health care delivery in the United States (10th Ed.), New York, NY: Springer Publishing.
Morrison, E. (2010). Ethics in health administration, Mississauga: Jones & Bartlett Learning
Sullivan, J. D. (2010). End Stage Renal Disease economics and the balance of treatment modalities. Journal of Service Science & Management, 3(1), 45–50.
Is this your assignment or some part of it?
We can do it for you! Click to Order!
