The Medicare End-Stage Renal Disease Program

Abstract

DURING the 1960s it became increasingly clear that patients with permanent kidney failure, previously certain to die, could be kept alive and in at least reasonably good health by long-term dialysis. At the same time, kidney transplantation was becoming increasingly successful as a result of improved programs of immunosuppression. Because of the high cost of these forms of therapy, especially long-term dialysis, and limited and fragmentary sources for payment of these costs, many patients were unable to obtain medically appropriate treatment for lack of funds. In 1972, Congress amended the Social Security Act to provide an entitlement to Medicare for persons with end-stage kidney failure regardless of age. This end-stage renal disease (ESRD) program is a unique part of Medicare in that it is the only entitlement based on the diagnosis of a medical condition. From the clinical perspective, the ESRD program has been very successful, saving several hundred thousand Americans from premature death. At present, nearly 150,000 patients with ESRD are receiving Medicare benefits. Moreover, from an ethical perspective the program has greatly enhanced equity of access to life-preserving therapy.¹