Sunday, August 22, 2010
Government Policy and Stupidity Concerning Kidney Transplants - A Personal Account by Ed Morrissey
See this - The gist is spot on - even if not every detail might not be.
Wednesday, August 18, 2010
Government Transplant Policy - Stupidity and Inefficiency which Result in Higher Mortality Rates for People with ESRD, Part I
See below for a brief history of ESRD coverage in the U.S.
Be aware of the following.
From the perspective of the law (as amended) as it is currently interpreted and enforced, if someone has a successful kidney transplant and only needs ~$12,000 per year for his anti-rejection medicine whereas continued dialysis and related medical costs can easily be ~$100,000, the government would pay the ~$100,000 for dialysis but not the ~$12,000 for the medicine. This actually causes people to stay on dialysis if they are concerned about being able to afford their medication after a successful transplant. Is this a broken policy, or what? By the way, life expectancy is significantly reduced and quality of life is substantially diminished for people on dialysis.
History
"On October 30, 1972, President Richard Nixon signed
section 2991 of Public Law 92–603, or the 1972
amendments to the Social Security Act. Enacted in
July 1973, provisions within this amendment established endstage
renal disease (ESRD) as the only healthcare condition to
be covered under Medicare for persons under the age of 65 and
without other disabilities." (Jonathan Himmelfarb and Glenn M. Chertow) J Am Soc Nephrol 16: 1164–1165, 2005. Check out this url for the article, in full
http://jasn.asnjournals.org/cgi/reprint/16/5/1164.pdf
See also the url below for amendment history
http://content.healthaffairs.org/cgi/reprint/18/1/161.pdf
Be aware of the following.
From the perspective of the law (as amended) as it is currently interpreted and enforced, if someone has a successful kidney transplant and only needs ~$12,000 per year for his anti-rejection medicine whereas continued dialysis and related medical costs can easily be ~$100,000, the government would pay the ~$100,000 for dialysis but not the ~$12,000 for the medicine. This actually causes people to stay on dialysis if they are concerned about being able to afford their medication after a successful transplant. Is this a broken policy, or what? By the way, life expectancy is significantly reduced and quality of life is substantially diminished for people on dialysis.
History
"On October 30, 1972, President Richard Nixon signed
section 2991 of Public Law 92–603, or the 1972
amendments to the Social Security Act. Enacted in
July 1973, provisions within this amendment established endstage
renal disease (ESRD) as the only healthcare condition to
be covered under Medicare for persons under the age of 65 and
without other disabilities." (Jonathan Himmelfarb and Glenn M. Chertow) J Am Soc Nephrol 16: 1164–1165, 2005. Check out this url for the article, in full
http://jasn.asnjournals.org/cgi/reprint/16/5/1164.pdf
See also the url below for amendment history
http://content.healthaffairs.org/cgi/reprint/18/1/161.pdf
Monday, August 16, 2010
RESEARCH PROPOSAL, DISTANCE TO AND SIZE OF KIDNEY TRANSPLANT CENTER EFFECT ON THE SPEED OF OBTAINING TRANSPLANT, PART II: ANALYSIS PLAN
Analysis Plan
ALL RIGHTS RESERVED TO THE AUTHOR
For this study, the data will be analyzed in the following manner. The following measures will be used to describe the sample characteristics. Distance from transplant center will be measured in average miles of all peoples’ places of residences were located away from the transplant centers. Transplant center size will be determined by the average numbers of transplants done in all transplant centers in a given year. The speed with which a person obtains a transplant will be determined by the average number of months it took to obtain the kidney transplant once they went on the kidney transplant waiting list. Sex and race will be given in percentages. Age will be given as an average. Nominal variables like level of education, level of religiosity, and opinions about the transplant process will be given in percentages.
Pearson’s r regression will be used to test the correlation between transplant center size and the time a person spends on the kidney transplant waiting list. Pearson’s r regression will also be used to test the correlation between the distance in miles a person lives away from the transplant center and the time a person spends on the kidney transplant waiting list. Pearson’s r regression is an appropriate measure to test the correlation because all of the independent and dependent variables are ratio levels of measurement.
The main hypotheses will be tested as follows. If the Pearson’s r correlation coefficient is within the absolute value of .5 then the size of the transplant center and the distance a person lives away from the transplant centers will be considered weak correlations and not strong predictors for the speed with which a person is able to obtain a kidney transplant. If the Pearson’s r correlation coefficient is greater than the absolute value of .5 then the size of the transplant center and the distance a person lives away from the transplant centers will be considered strong correlations and strong predictors for the speed with which a person is able to obtain a kidney transplant.
Therefore, for the hypothesis that the closer a person lives to a transplant center the quicker that they will receive a kidney transplant, if the correlation is greater than or equal to .5, then the hypothesis will be accepted and therefore, the closer a person lives to a transplant center, the quicker that they will receive a kidney transplant. If the correlation is between -1 and less than .5 we will reject the hypothesis.
Also, therefore, for the hypothesis that the greater the quantity of kidney transplants done annually at a transplant center then the quicker the people on the waiting list at that transplant center will obtain a transplant, if the correlation is greater than or equal to .5, then the hypothesis will be accepted and therefore the more transplant a center does the quicker a person will obtain a transplant. If the correlation is between -1 and less than .5 we will reject the hypothesis. This is how the hypotheses will be measured in the hopes that the findings will increase the understanding of the speed of the kidney transplant process in the U.S.
ALL RIGHTS RESERVED TO THE AUTHOR
For this study, the data will be analyzed in the following manner. The following measures will be used to describe the sample characteristics. Distance from transplant center will be measured in average miles of all peoples’ places of residences were located away from the transplant centers. Transplant center size will be determined by the average numbers of transplants done in all transplant centers in a given year. The speed with which a person obtains a transplant will be determined by the average number of months it took to obtain the kidney transplant once they went on the kidney transplant waiting list. Sex and race will be given in percentages. Age will be given as an average. Nominal variables like level of education, level of religiosity, and opinions about the transplant process will be given in percentages.
Pearson’s r regression will be used to test the correlation between transplant center size and the time a person spends on the kidney transplant waiting list. Pearson’s r regression will also be used to test the correlation between the distance in miles a person lives away from the transplant center and the time a person spends on the kidney transplant waiting list. Pearson’s r regression is an appropriate measure to test the correlation because all of the independent and dependent variables are ratio levels of measurement.
The main hypotheses will be tested as follows. If the Pearson’s r correlation coefficient is within the absolute value of .5 then the size of the transplant center and the distance a person lives away from the transplant centers will be considered weak correlations and not strong predictors for the speed with which a person is able to obtain a kidney transplant. If the Pearson’s r correlation coefficient is greater than the absolute value of .5 then the size of the transplant center and the distance a person lives away from the transplant centers will be considered strong correlations and strong predictors for the speed with which a person is able to obtain a kidney transplant.
Therefore, for the hypothesis that the closer a person lives to a transplant center the quicker that they will receive a kidney transplant, if the correlation is greater than or equal to .5, then the hypothesis will be accepted and therefore, the closer a person lives to a transplant center, the quicker that they will receive a kidney transplant. If the correlation is between -1 and less than .5 we will reject the hypothesis.
Also, therefore, for the hypothesis that the greater the quantity of kidney transplants done annually at a transplant center then the quicker the people on the waiting list at that transplant center will obtain a transplant, if the correlation is greater than or equal to .5, then the hypothesis will be accepted and therefore the more transplant a center does the quicker a person will obtain a transplant. If the correlation is between -1 and less than .5 we will reject the hypothesis. This is how the hypotheses will be measured in the hopes that the findings will increase the understanding of the speed of the kidney transplant process in the U.S.
Sunday, August 15, 2010
RESEARCH PROPOSAL: The effect of distance from kidney transplant center and the effect of size of kidney transplant center on the speed of kidney transplantation in the U.S., Part I
Eliyahu Lazovsky
Northern Illinois University
Department of Public Health
PHHE 611
All rights reserved to the author.
Monday, December 7, 2009
Project Summary
The objective of this study is to study the correlation between the distance transplants recipients live from their transplant centers and the speed with which they obtain a transplant. The study also studies the correlation between the quantity of transplants done at a given transplant center and the speed with which they obtain a transplant.
One hypothesis that is being tested is the closer a person lives to a transplant center, the less time they will spend on the kidney transplant waiting. Another hypothesis that is being tested is the greater the quantity of kidney transplants performed at the person’s transplant center, the less time that will be spent on the kidney transplant waiting list.
The study will be a cross-sectional systematic sample of 1,000 people out of the approximately 10,000 people who received kidney transplants from the U.S. kidney transplant waiting list from the from January, 1, 2000 through December 31, 2009. A questionnaire with questions relating to the participants’ kidney transplantation experiences will be the source of the data.
There is an extreme shortage of kidneys available for transplantation in the United States. Thousands of people die annually while awaiting a transplant that they never receive. This study attempts to determine whether geographical distance to a transplant center measured in miles and the size of the transplant center measured by the number of kidney transplants performed annually at the center play a role in the speed with which a person obtains a kidney transplant.
Lessons learned from this study can be used to assess the equity of the current transplant process and to help determine which variables currently are associated with quicker access to kidney transplantation. Hopefully, lessons learned from people who receive their kidney transplants in a quicker time frame can be applied to currently underserved and more slowly served populations to decrease their time on the waiting list which will also lead to a decrease in this population’s mortality rate.
Background
In 2006, 3,916 people in the U.S. died while awaiting a kidney transplant. (“25 Facts,” 2008). These people, the grieving families they left behind, and all of the people on the transplant waiting list are the reasons this study is important. There were “87,654 deaths in all patients undergoing ESRD [end stage renal disease] treatment” in 2006. (“Kidney and,” 2008). There is a great need cut down the number of deaths from ESRD.
This descriptive study will attempt to investigate the effect geographical proximity to a major transplant center and the size of the transplant center have on the speed with which a person is able to obtain a kidney transplant after they have been placed on the kidney transplant waiting list.
The research questions are: what type of association is there between the distance to a transplant center and the time a person spends on the waiting list awaiting their kidney transplant; and what type of association is there between the size of the transplant center and the time a person spends on the waiting list awaiting their kidney transplant.
“Transplant center size and proximity, as well as regional variations in matching algorithms, may also play a role” in patients abilities to obtain a kidney transplant. (Alexander, 1998, p.1151).
Intuitively, it would seem that the closer one lives to a major transplant center, the higher the chance of the patient getting a kidney transplant because then there is the expertise and infrastructure in place (the kidney needs to be transplanted quickly so it doesn’t die before it is implanted into the patient.)
A study of people on the Scotland renal registry analyzed data to determine various characteristics of people and how it effected their chances of being put on the transplant waiting list and the chance of getting kidney transplants (Oniscu, 2003, p.1). This study found that the further a person lived from a transplant center, the quicker they were put on a kidney transplant waiting list, but once they were on the list, they obtained the kidneys at similar speeds to people who lived closer to the transplant center (p.2). It also found inequities which included inequities based on distance the patient was from the transplant center, sex, dialysis status, and at which transplant center was the patient put on the waiting list (p.4). The study does not focus on the affect the size of the transplant center has on the speed of the transplant. This study also only studies people on the Scotland Renal Registry.
This study will use the same type of approach to study the U.S. transplant center because laws and algorithms that calculate and govern who gets organs and when they get them change from country to country so this study will add to the literature by seeing how various characteristics affect the speed with which a person can obtain a kidney transplant in the U.S.
This study will also add internationally to the literature by examining the effect of the size of the transplant center has on the amount of time a person spends on the U.S. kidney transplant waiting list. A similar study has not been found in the literature review. Studies have been done that compare transplants centers to each other, but they have never focuses on the effect that the quantity of transplant s performed at each center has on the speed with which a transplant is obtained by people at that center compared to people at other centers.
Speed with which a person obtains a transplant is crucial because the longer a person remains on dialysis, the worse the outcomes of the kidney transplants tend to be. “Waiting time had the strongest effect on survival once a patient got on a transplant list. At centers with the longest wait times, patients' risk of death was a third higher than at those with the shortest waits”(“Shorter Wait,” 2009). This is why this study will focus on speed of the transplant. The quicker the patient obtains a transplant, the lower their risk of death.
Some studies acknowledge that proximity to transplant center may play a role but this study will try to determine what role demographic characteristics play. Many studies compare the chances of obtaining a transplant based on demographic characteristics but this study will attempt to study the speed with which various demographic groups are able to obtain a transplant, not just whether they get a transplant or don’t get a transplant.
Northern Illinois University
Department of Public Health
PHHE 611
All rights reserved to the author.
Monday, December 7, 2009
Project Summary
The objective of this study is to study the correlation between the distance transplants recipients live from their transplant centers and the speed with which they obtain a transplant. The study also studies the correlation between the quantity of transplants done at a given transplant center and the speed with which they obtain a transplant.
One hypothesis that is being tested is the closer a person lives to a transplant center, the less time they will spend on the kidney transplant waiting. Another hypothesis that is being tested is the greater the quantity of kidney transplants performed at the person’s transplant center, the less time that will be spent on the kidney transplant waiting list.
The study will be a cross-sectional systematic sample of 1,000 people out of the approximately 10,000 people who received kidney transplants from the U.S. kidney transplant waiting list from the from January, 1, 2000 through December 31, 2009. A questionnaire with questions relating to the participants’ kidney transplantation experiences will be the source of the data.
There is an extreme shortage of kidneys available for transplantation in the United States. Thousands of people die annually while awaiting a transplant that they never receive. This study attempts to determine whether geographical distance to a transplant center measured in miles and the size of the transplant center measured by the number of kidney transplants performed annually at the center play a role in the speed with which a person obtains a kidney transplant.
Lessons learned from this study can be used to assess the equity of the current transplant process and to help determine which variables currently are associated with quicker access to kidney transplantation. Hopefully, lessons learned from people who receive their kidney transplants in a quicker time frame can be applied to currently underserved and more slowly served populations to decrease their time on the waiting list which will also lead to a decrease in this population’s mortality rate.
Background
In 2006, 3,916 people in the U.S. died while awaiting a kidney transplant. (“25 Facts,” 2008). These people, the grieving families they left behind, and all of the people on the transplant waiting list are the reasons this study is important. There were “87,654 deaths in all patients undergoing ESRD [end stage renal disease] treatment” in 2006. (“Kidney and,” 2008). There is a great need cut down the number of deaths from ESRD.
This descriptive study will attempt to investigate the effect geographical proximity to a major transplant center and the size of the transplant center have on the speed with which a person is able to obtain a kidney transplant after they have been placed on the kidney transplant waiting list.
The research questions are: what type of association is there between the distance to a transplant center and the time a person spends on the waiting list awaiting their kidney transplant; and what type of association is there between the size of the transplant center and the time a person spends on the waiting list awaiting their kidney transplant.
“Transplant center size and proximity, as well as regional variations in matching algorithms, may also play a role” in patients abilities to obtain a kidney transplant. (Alexander, 1998, p.1151).
Intuitively, it would seem that the closer one lives to a major transplant center, the higher the chance of the patient getting a kidney transplant because then there is the expertise and infrastructure in place (the kidney needs to be transplanted quickly so it doesn’t die before it is implanted into the patient.)
A study of people on the Scotland renal registry analyzed data to determine various characteristics of people and how it effected their chances of being put on the transplant waiting list and the chance of getting kidney transplants (Oniscu, 2003, p.1). This study found that the further a person lived from a transplant center, the quicker they were put on a kidney transplant waiting list, but once they were on the list, they obtained the kidneys at similar speeds to people who lived closer to the transplant center (p.2). It also found inequities which included inequities based on distance the patient was from the transplant center, sex, dialysis status, and at which transplant center was the patient put on the waiting list (p.4). The study does not focus on the affect the size of the transplant center has on the speed of the transplant. This study also only studies people on the Scotland Renal Registry.
This study will use the same type of approach to study the U.S. transplant center because laws and algorithms that calculate and govern who gets organs and when they get them change from country to country so this study will add to the literature by seeing how various characteristics affect the speed with which a person can obtain a kidney transplant in the U.S.
This study will also add internationally to the literature by examining the effect of the size of the transplant center has on the amount of time a person spends on the U.S. kidney transplant waiting list. A similar study has not been found in the literature review. Studies have been done that compare transplants centers to each other, but they have never focuses on the effect that the quantity of transplant s performed at each center has on the speed with which a transplant is obtained by people at that center compared to people at other centers.
Speed with which a person obtains a transplant is crucial because the longer a person remains on dialysis, the worse the outcomes of the kidney transplants tend to be. “Waiting time had the strongest effect on survival once a patient got on a transplant list. At centers with the longest wait times, patients' risk of death was a third higher than at those with the shortest waits”(“Shorter Wait,” 2009). This is why this study will focus on speed of the transplant. The quicker the patient obtains a transplant, the lower their risk of death.
Some studies acknowledge that proximity to transplant center may play a role but this study will try to determine what role demographic characteristics play. Many studies compare the chances of obtaining a transplant based on demographic characteristics but this study will attempt to study the speed with which various demographic groups are able to obtain a transplant, not just whether they get a transplant or don’t get a transplant.
Saturday, August 14, 2010
Government's Policy outlawing "valuable consideration" for organ transplants kills people every day
All Rights Reserved to the Author
Policy Paper
PHHE 671
Eliyahu Lazovsky
December 1, 2009
Governmental Economic Policies to Increase Supply of Kidneys Available for Transplantation
The purpose of this proposed policy is to increase the numbers of kidneys available for transplantation. The methods will include government tax credits to live donors and the families or estates of deceased donors. Another method will be to align the incentives of current Medicare policies to focus on the current best standards for treatment of ESRD (end stage renal disease) and not merely the current model which focuses on treatment (dialysis treatment) and not on a cure (a kidney transplant.) “Kidney transplantation is the most successful and cost effective treatment for renal failure and should represent the gold standard, yet not all patients receiving dialysis are suitable for transplantation, and there is evidence that selection criteria vary widely” (Oniscu, 2003, p.1).
Currently many people die annually while awaiting a renal transplant, otherwise known as a kidney transplant. “As of June 2008, there were more than 75,000 people on the kidney transplant list in America. Sadly, about 12 of these patients die every day while awaiting a kidney” (Brochure, Alliance for paired donation, 2008, p. 2). Also, on average, people who receive ideal kidney organs for transplants live over 13 years longer compared to those on dialysis (Ojo, 2001, p. 592).
There is currently a government policy forbidding “valuable consideration” which is legalese for money to be exchanged between parties in order for one party to supply a kidney to the other party who is suffering from ESRD. This policy was introduced as an attempt to squelch the market for trafficking of human organs. While the intentions might arguably have been noble at the time the legislation was passed, with the benefit of hindsight, the unintended consequence of this legislation leads to additional thousands of people dying annually who are on the U.S. kidney transplantation waiting registry but succumb to the vagaries of ESRD before a kidney become available for transplantation.
A further complication in the supply of kidneys available for transplantation is that under a change to Medicare passed during the presidency of Richard Nixon, medical care associated with ESRD is covered for all Americans. In other words, we have nationalized health care in the U.S. for the treatment of ESRD. The federal government pays, for among other things, the costs associated with dialysis, which is the treatment given to people who are suffering for ESRD when their kidneys are no longer able to filter out the toxins from their blood streams and so this cleansing is done artificially by a blood dialyzer.
There is a quirk in the federal government’s coverage of ESRD which encourages people to remain on dialysis (a treatment) instead of pursuing a kidney transplant (a cure) because the federal government stops insuring people who formally had ESRD three years after the kidney transplant. This is due to a law passed by Congress in 1999 which made it illegal to pay for the immunosuppressant drugs for more than 3 years after transplantation. This creates an externality whereby people who cannot afford the very expensive anti-rejection medications which can cost up to around $1500 per month (and transplant recipients must take these medications for the remainder of their lives to lower the risk that the graft will be rejected.) opt to remain on dialysis instead of pursuing a transplant.
“Expenditures per patient year show parallel trends, with hemodialysis costs at $71,889 in 2006, compared to $53,327 and $24,951, respectively, for peritoneal dialysis and transplant” (Report, 2008, figures 11.8 and 11.9).
The government lowers the supply of kidneys available, thus distorting the market by lowering the supply of kidney available to the market. The government also reimburses much more money for dialysis than it does for kidney transplants, which are cheaper, and more importantly, cures the patient and improves the patient’s quality of life because they no longer need to be hooked up to a dialysis machine for hours at a time (Medicare spends $150,000 annually on dialysis patients versus $17,000 annually for post transplant patients) (Article, Kidney Transplantation, 2009).
I propose a two pronged approach to deal with the problem. First of all, I propose a $50,000 tax refund for anyone who makes a live or deceased kidney donation. This will cause a larger supply of kidneys to be available for transplantation. Also, since everyone gets the same amount of money from the government, this should work to crowd out the illegal black market for kidney organs.
I also propose a change in the Medicare reimbursement structure to encourage kidney transplants. This should increase the incentive to doctors to perform more transplants with the newly increased supply of kidneys available for transplantation. Also, the government will provide lifetime Medicare coverage to former ESRD patients who receive transplants who do not have their own medical coverage which covers anti-rejection medication to make sure people who could get a transplant but who cannot afford the anti-rejections medications do not opt against transplantation which is actually worse for their health and much more costly in the long run.
There are two very important aspects to these policies. One aspect is that kidney transplantation increases the life expectancy of the patient compared to a patient on dialysis. Additionally, this policy would probably save the government money in the long run because transplants are much cheaper than dialysis and they are a one time occurrence, not something that the government needs to keep paying for year after year like dialysis. Also, the patients for whom the government continues to pay anti-rejection medication, this is substantially cheaper than dialysis treatment.
Economically, the government will focus on subsidizing kidney transplants instead of focusing on subsidizing dialysis. This shift in subsidy strategy will increase the supply of kidneys to the market and the supply curve will shift outward and the new equilibrium point will result in the quantity of kidney transplants shifting out, thus increasing the number of transplants that will take place. This will also decrease the dead weight loss to the society that currently exists from more money being spent on dialysis than the market would demand if not for the government guaranteeing payment for all patients with ESRD. This money can be spent on much better things – like on the kidney transplants themselves.
Works Cited
1. Alliance for paired donation. Brochure. (2008). Retrieved from
http://paireddonation.org/files/brochures/APD-Patient-broch-ENGL.pdf on November 27, 2009.
2. Kidney Transplantation. (2009) Wikipedia. Retrieved from
http://en.wikipedia.org/wiki/Kidney_transplantation on December 1, 2009.
3. OJO, AKINLOLU O., HANSON, JULIE A., MEIER-KRIESCHE, HERWIG-ULF,
OKECHUKWU, CHIKE N., et. al. (2001). Survival in Recipients of Marginal Cadaveric Donor Kidneys Compared with Other Recipients and Wait-Listed Transplant Candidates. Journal of American Society of Nephrology, pp. 12: 589–597. Retrieved from http://jasn.asnjournals.org/cgi/reprint/12/3/589 on November 14, 2009.
4. Oniscu, Gabriel C., Schalkwijk, Annemarie A. H., Johnson, Rachel J., Brown,
Helen, and John L. R. Forsythe. (2003). Equity of access to renal transplant waiting list and renal transplantation in Scotland: Cohort study. BMJ (British Medical Journal). Retrieved from http://www.bmj.com/cgi/reprint/327/7426/1261 on December 1, 2009.
5. United States Renal Data System. (2009) USRDS Annual Data Report 2008. Figures 11.7 and 11.8. Retreived from http://www.usrds.org/2008/view/esrd_11.asp on November 26, 2009.
Policy Paper
PHHE 671
Eliyahu Lazovsky
December 1, 2009
Governmental Economic Policies to Increase Supply of Kidneys Available for Transplantation
The purpose of this proposed policy is to increase the numbers of kidneys available for transplantation. The methods will include government tax credits to live donors and the families or estates of deceased donors. Another method will be to align the incentives of current Medicare policies to focus on the current best standards for treatment of ESRD (end stage renal disease) and not merely the current model which focuses on treatment (dialysis treatment) and not on a cure (a kidney transplant.) “Kidney transplantation is the most successful and cost effective treatment for renal failure and should represent the gold standard, yet not all patients receiving dialysis are suitable for transplantation, and there is evidence that selection criteria vary widely” (Oniscu, 2003, p.1).
Currently many people die annually while awaiting a renal transplant, otherwise known as a kidney transplant. “As of June 2008, there were more than 75,000 people on the kidney transplant list in America. Sadly, about 12 of these patients die every day while awaiting a kidney” (Brochure, Alliance for paired donation, 2008, p. 2). Also, on average, people who receive ideal kidney organs for transplants live over 13 years longer compared to those on dialysis (Ojo, 2001, p. 592).
There is currently a government policy forbidding “valuable consideration” which is legalese for money to be exchanged between parties in order for one party to supply a kidney to the other party who is suffering from ESRD. This policy was introduced as an attempt to squelch the market for trafficking of human organs. While the intentions might arguably have been noble at the time the legislation was passed, with the benefit of hindsight, the unintended consequence of this legislation leads to additional thousands of people dying annually who are on the U.S. kidney transplantation waiting registry but succumb to the vagaries of ESRD before a kidney become available for transplantation.
A further complication in the supply of kidneys available for transplantation is that under a change to Medicare passed during the presidency of Richard Nixon, medical care associated with ESRD is covered for all Americans. In other words, we have nationalized health care in the U.S. for the treatment of ESRD. The federal government pays, for among other things, the costs associated with dialysis, which is the treatment given to people who are suffering for ESRD when their kidneys are no longer able to filter out the toxins from their blood streams and so this cleansing is done artificially by a blood dialyzer.
There is a quirk in the federal government’s coverage of ESRD which encourages people to remain on dialysis (a treatment) instead of pursuing a kidney transplant (a cure) because the federal government stops insuring people who formally had ESRD three years after the kidney transplant. This is due to a law passed by Congress in 1999 which made it illegal to pay for the immunosuppressant drugs for more than 3 years after transplantation. This creates an externality whereby people who cannot afford the very expensive anti-rejection medications which can cost up to around $1500 per month (and transplant recipients must take these medications for the remainder of their lives to lower the risk that the graft will be rejected.) opt to remain on dialysis instead of pursuing a transplant.
“Expenditures per patient year show parallel trends, with hemodialysis costs at $71,889 in 2006, compared to $53,327 and $24,951, respectively, for peritoneal dialysis and transplant” (Report, 2008, figures 11.8 and 11.9).
The government lowers the supply of kidneys available, thus distorting the market by lowering the supply of kidney available to the market. The government also reimburses much more money for dialysis than it does for kidney transplants, which are cheaper, and more importantly, cures the patient and improves the patient’s quality of life because they no longer need to be hooked up to a dialysis machine for hours at a time (Medicare spends $150,000 annually on dialysis patients versus $17,000 annually for post transplant patients) (Article, Kidney Transplantation, 2009).
I propose a two pronged approach to deal with the problem. First of all, I propose a $50,000 tax refund for anyone who makes a live or deceased kidney donation. This will cause a larger supply of kidneys to be available for transplantation. Also, since everyone gets the same amount of money from the government, this should work to crowd out the illegal black market for kidney organs.
I also propose a change in the Medicare reimbursement structure to encourage kidney transplants. This should increase the incentive to doctors to perform more transplants with the newly increased supply of kidneys available for transplantation. Also, the government will provide lifetime Medicare coverage to former ESRD patients who receive transplants who do not have their own medical coverage which covers anti-rejection medication to make sure people who could get a transplant but who cannot afford the anti-rejections medications do not opt against transplantation which is actually worse for their health and much more costly in the long run.
There are two very important aspects to these policies. One aspect is that kidney transplantation increases the life expectancy of the patient compared to a patient on dialysis. Additionally, this policy would probably save the government money in the long run because transplants are much cheaper than dialysis and they are a one time occurrence, not something that the government needs to keep paying for year after year like dialysis. Also, the patients for whom the government continues to pay anti-rejection medication, this is substantially cheaper than dialysis treatment.
Economically, the government will focus on subsidizing kidney transplants instead of focusing on subsidizing dialysis. This shift in subsidy strategy will increase the supply of kidneys to the market and the supply curve will shift outward and the new equilibrium point will result in the quantity of kidney transplants shifting out, thus increasing the number of transplants that will take place. This will also decrease the dead weight loss to the society that currently exists from more money being spent on dialysis than the market would demand if not for the government guaranteeing payment for all patients with ESRD. This money can be spent on much better things – like on the kidney transplants themselves.
Works Cited
1. Alliance for paired donation. Brochure. (2008). Retrieved from
http://paireddonation.org/files/brochures/APD-Patient-broch-ENGL.pdf on November 27, 2009.
2. Kidney Transplantation. (2009) Wikipedia. Retrieved from
http://en.wikipedia.org/wiki/Kidney_transplantation on December 1, 2009.
3. OJO, AKINLOLU O., HANSON, JULIE A., MEIER-KRIESCHE, HERWIG-ULF,
OKECHUKWU, CHIKE N., et. al. (2001). Survival in Recipients of Marginal Cadaveric Donor Kidneys Compared with Other Recipients and Wait-Listed Transplant Candidates. Journal of American Society of Nephrology, pp. 12: 589–597. Retrieved from http://jasn.asnjournals.org/cgi/reprint/12/3/589 on November 14, 2009.
4. Oniscu, Gabriel C., Schalkwijk, Annemarie A. H., Johnson, Rachel J., Brown,
Helen, and John L. R. Forsythe. (2003). Equity of access to renal transplant waiting list and renal transplantation in Scotland: Cohort study. BMJ (British Medical Journal). Retrieved from http://www.bmj.com/cgi/reprint/327/7426/1261 on December 1, 2009.
5. United States Renal Data System. (2009) USRDS Annual Data Report 2008. Figures 11.7 and 11.8. Retreived from http://www.usrds.org/2008/view/esrd_11.asp on November 26, 2009.
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