A new study has found that Americans who have dialysis done at private, for-profit centers face an 8 percent higher risk of death than those who seek the treatment at private, non-profit clinics.
The research also suggests that 2,500 deaths a year, and possibly many more, could be prevented by switching kidney patients to the non-profit dialysis centers.
For-profit dialysis units typically have smaller staffs with less well-trained nurses and technicians than their non-profit alternatives. Patients also generally attend for-profit clinics for shorter periods, which has been associated with higher mortality rates.
The argument for profiteering dialysis facilities is that market competition will lead to cost savings without sacrificing patient safety. However, Dr. P.J. Devereaux, a Canadian cardiologist and co-author of the new study, says that's not happening.
"What our research keeps showing is that, instead of creating efficiencies, people are cutting the quality of care," he says.
Devereaux and his colleagues report their findings in tomorrow's Journal of the American Medical Association.
Medicare had nearly 286,000 dialysis patients in 2001, up from 142,000 a decade ago, according to the Centers for Medicare and Medicaid Services. Of those, 258,000 received treatment at outpatient clinics and about 28,000 had the procedure done at home.
The government insurance program had approved more than 67,000 dialysis facilities as of last year, of which roughly 75 percent were for-profit.
Devereaux and his colleagues, including doctors in the United States, reviewed eight earlier studies of freestanding dialysis centers, using data collected from 1973 though 1997. Each study covered an average of more than 1,300 clinics, and six of the eight found a statistically meaningful increase in death rates at for-profit centers.
One study seemed to give an advantage to for-profit clinics. However, it was drowned out by the others, leaving an average death rate 8 percent higher than in the non-profit centers.
That figure may underestimate the true effect, Devereaux adds, because the most rigorous study -- with the best adjustments for age, sex and severity of illness leading to kidney failure -- had the biggest gap, of 18 percent.
Devereaux says the results should be a signal to Canadian policy makers, who are now debating the feasibility of profit-driven dialysis centers in that country.
Michael Paget, executive director of the National Renal Administrators Association, a trade group representing about 700 dialysis center managers, would not comment on the latest findings.
However, Paget says, "I don't see how [profit motive] makes any difference for how they operate."
The Centers for Medicare and Medicaid Services, a division of the Department of Health and Human Services, did not have anyone immediately available to comment on the study.
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