End-Stage Renal Disease and the ''Cost'' of Medical Technology

by Richard A. Rettig


Download eBook for Free

FormatFile SizeNotes
PDF file 2.2 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.


Purchase Print Copy

 FormatList Price Price
Add to Cart Paperback55 pages $23.00 $18.40 20% Web Discount

Reviews developments since Sec. 299I of Public Law 92-603 went into effect, extending Medicare coverage for hemodialysis and renal transplantation for chronic kidney failure. This paper analyzes sources of difficulties surrounding this program, and draws out lessons having potential for other expensive, life-saving technologies. The author reviews the history of hemodialysis and renal transplantation progress, and outlines cost problems of the end-stage renal disease program including lack of accurate cost estimates at inception, failure of the program to transfer many patients to home dialysis, and failure to lower costs by advances in technology. Some lessons drawn from this experience: (1) Efforts to predict dynamics of clinical developments are likely to be wrong in important aspects. (2) R&D is needed on etiology, pathogenesis, and treatment and prevention of disease states for which there is patient treatment benefit program. (3) Policy decisions that allocate scarce resources for saving relatively few lives deserve thoughtful deliberation.

This report is part of the RAND Corporation paper series. The paper was a product of the RAND Corporation from 1948 to 2003 that captured speeches, memorials, and derivative research, usually prepared on authors' own time and meant to be the scholarly or scientific contribution of individual authors to their professional fields. Papers were less formal than reports and did not require rigorous peer review.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.