Hirth RA, Chernew ME, Orzol SM; International Society of Technology Assessment in Health Care. Meeting.

Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1998; 14: 76.

Department of Health Management & Policy, University of Michigan, Ann Arbor, MI, USA.

OBJECTIVE: The Medicare End-Stage Renal Disease program provides a unique opportunity to examine a system within the U.S. that has placed providers under cost control pressure for several decades. Dialysis facilities are paid in a manner that closely approximates capitation. Examining the determinants of adoption of new technologies and the cost-saving tradeoffs that have been made to facilitate the adoption of otherwise cost-increasing technologies can yield insights into the possible responses of other segments of the U.S. health care industry to cost control. METHODS: We examined the use of 4 potentially quality-enhancing technologies (bicarbonate dialysate, biocompatible dialyzer membranes, high flux dialysis, and high efficiency dialysis) and 2 cost-saving practices (reuse of dialyzer membranes and reductions in staffing). We estimated multivariate models of the adoption and use of each technology or practice. Predictors included characteristics of the dialysis facility and the facility's patients, area, and competitive and regulatory environments. The data set includes all U.S. dialysis units from 1985-1993. RESULTS: Several findings were consistent across the study measures and years. Nonprofit, hospital-based, urban, larger, and newer units were more likely to adopt newer, potentially quality enhancing technologies, as were units with lower proportions of African-American patients. Most types of units that adopted new technologies more rapidly were more likely to reuse dialyzers and had lower staffing ratios, indicating that these cost savings facilitated the use of new technologies. However, nonprofit and hospital-based units did not appear to engage in such tradeoffs. Units in more competitive markets were more likely to adopt new technologies but were no more likely to rely on cost-saving practices. CONCLUSIONS: Medicare's stringent capitated dialysis payment (65% real price reduction since the early 1970s) does not appear to have blocked access to several new, quality-enhancing technologies because, for these technologies, facilities appear able to adjust along other margins. Usings more expensive dialyzer membranes could be made economically feasible by sterilization and reuse. However, reuse has been implicated as a mortality risk factor indicating that these tradeoffs may not be costless. Likewise, new dialysis methods, such as high flux or high efficiency, reduce treatment times, allowing reductions in staffing. Finally, the positive effects of competition and nonprofit ownership provide reason for concern given the growing prevalence of large, for-profit chains in the dialysis industry and other segments of the health care industry.

Publication Types:

• Meeting Abstracts

Keywords:

• Adoption
• Cost Control
• Cost Savings
• Dialysis
• Humans
• Kidney Failure, Chronic
• Medicare
• Ownership
• Peritoneal Dialysis
• Renal Dialysis
• United States
• economics
• hsrmtgs

Other ID:

• HTX/99600328

UI: 102237006

From Meeting Abstracts