Patients with kidney disease who are treated at for-profit dialysis centers are more likely to die and less likely to be placed on a waiting list for a kidney transplant than patients at not-for-profit centers, according to a study by investigators at Johns Hopkins School of Public Health in Baltimore.
Pushkal P. Garg, MD, and colleagues reported on November 25 in The New England Journal of Medicine that, at for-profit centers, mortality rates were 20% higher and there was a 26% lower likelihood that patients would be put on a waiting list (1999;341:1653-1660). The study was based on 3,569 patients with endstage renal disease (ESRD) who were treated by 950 dialysis providers.
"Our results raise serious concern that provider decision making may differ within for-profit and not-for-profit organizations and that the care of patients with endstage renal disease may be compromised in for-profit dialysis centers, particularly in localities where not-for-profit facilities are absent," said senior author Neil R. Powe, MD. The association between for-profit centers and poor outcomes was diminished in counties where for-profit centers operated near not-for-profit dialysis centers.
"Given that approximately 140,000 patients were dialyzed in for-profit centers in 1997, the observed increase in the absolute mortality rate among patients in freestanding, for-profit centers suggests that a considerable number of ESRD deaths may be associated with for-profit treatment," Dr. Powe said. About two thirds of dialysis patients in the United States are treated at for-profit centers.
In an editorial accompanying the article, Norman G. Levinsky, MD, of Boston University of Medical Center called for the government to "use knowledge about the influence of ownership [of a dialysis center] in developing standards of quality" for Medicare's End Stage Renal Disease Program (1999;341:1691-1693).
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