Dialysis care: Three decades later

This is a classic article by Hampers and Hager in 1979 commenting on the delivery of dialysis services in the United States. Looking back some 32 years later, there are several fascinating aspects of this treatise.

First, the authors make a strong and passionate case for the delivery of outpatient dialysis services by the proprietary (for-profit) business entities in the U.S. This is particularly poignant today as the discussion and arguments are similar now just as they were then, and with the looming of the new healthcare bill recently passed by Congress the supporters and opponents of that bill are just as emotional and unyielding as we sensed in this paper. The specifics of the authors' arguments may no longer be relevant, but the general philosophy they outline is just as compelling today to some thought leaders as they were three decades ago.

Additionally, as the authors correctly predicted, the for-profit sector is winning the dialysis services battle, as illustrated by the ongoing consolidation in this arena by the large for-profit companies.

I could not help but smile when I read that federal health expenditures in 1976 represented 9.7% of the federal budget ($44.5 billion). What we would give today to have such a “low” percentage? Similarly, the median age of hemodialysis patients was around 51 years of age, a number we left in the dust long ago. The article also expressed the desire to move hemodialysis patients to home care as much as possible, an effort which is again gaining momentum in our country.

Despite the age of this article and the loss of relevance of some of its content, this is a remarkable commentary on the entire dialysis industry, and still rings mostly true today. It also gives us a unique retrospective on the evolution of the ESRD Program.