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October 23, 1981

The High Price of Federally Regulated Hemodialysis

JAMA. 1981;246(17):1909-1911. doi:10.1001/jama.1981.03320170021021

MEDICAL care in most countries operates in the milieu of business conditions characteristic of that country. It would be expected that in the United States, fee-for-service medicine, in which consumers (patients) seek quality care at a competitive price, would be the predominant modus operandi. As costs have soared, however, the federal government has taken an increasingly active role through publicly financed third-party programs to ensure coverage to those not able to afford excessive costs. Alterations in traditional free-market mechanisms have thus been taking place, one of which has been the creation of a consumer population primarily interested in receiving quality services without incentive to control costs and providers who have reversed those priorities. After nine years of operation as an experiment in national catastrophic insurance, the End-Stage Renal Disease (ESRD) program needs review in light of recent concerns regarding quality and cost control that have resulted from interference with free