The American health care system: the End Stage Renal Disease Program

Article Abstract:

The End Stage Renal Disease Program is a Medicare program that finances treatment for patients with kidney failure who need regular dialysis or kidney transplantation to live. The program, which Congress established in 1972, is the only disease-specific model offered by Medicare, and its annual per-patient cost - $29,000 - is nine times higher than the average per-patient cost for all of Medicare. Since it was originally created, the number of eligible patients has swelled from 10,000 to 165,000 while the real value of Medicare reimbursement payments to the hospitals and clinics actually providing the services has steadily declined. In response, facilities have reduced the number of registered nurses, social workers and dietitians who work with the patients, shortened dialysis sessions and increased the reuse of dialyzers. The Health Care Financing Administration is calling for further cuts in reimbursement rates for the program, perhaps jeopardizing the quality of care that organizations like the Institute of Medicine say is already questionable.

Care and treatment, Chronic kidney failure, End Stage Renal Disease Program

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Managed care and mental health

Article Abstract:

The management of mental health care has led to lower-cost services which may or may not be effective, has limited the independence of psychiatrists, and may restrict the care of chronic mental illnesses. The goal of managed care is to restrict service use. Several health maintenance organizations contract with companies that provide managed mental health care. These companies may be particularly susceptible to conflict of interest as the same people that provide care are trying to limit care. A growing number of corporations have contracts with these mental health care companies and are satisfied with the cost savings. State mental health authorities are also contracting with these companies to manage the care of people with Medicaid funding. The shift to managed care is also causing a shift away from care delivered by psychiatrists, particularly those at academic institutions.

Managed care plans (Medical care), Mental health benefits

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The American health care system: Medicare

Article Abstract:

Ensuring the survival of Medicare will be a continuing challenge as baby boomers reach retirement. Medicare's trustees estimated in 1992 that Medicare would run out of money by the year 2001. In response, Congress passed the Balanced Budget Act of 1997, which added about 300 provisions to Medicare to reduce the growth of the program and offer beneficiaries other options besides the traditional indemnity component. In the future, more costs may be shifted to beneficiaries in the form of vouchers for health care. The patient would have to pay for additional services not covered by the voucher.

Analysis, Medicare

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