The End-Stage Renal Disease Program: Here Are Some of the Data

Some 13 years ago, implementation of the Medicare End-Stage Renal Disease (ESRD) Program provided access to long-term dialysis and kidney transplantation for almost all patients in need in the United States. Since then the number of dialysis patients in this country has increased from 12 000 to more than 80000, and some 8000 kidney transplants were done last year. The annual cost of this program to Medicare is approaching $2 billion, and there are also significant expenditures from private insurance, Medicaid, various state funds, and from patients themselves. In 1973 the National Institutes of Health (NIH), the American College of Surgeons, and the Research Triangle Institute were responsible for successful transplant and dialysis registries, but in 1974 these were replaced by the ESRD Medical Information System, which was the responsibility of the Health Care Financing Administration (HCFA). The history of this registry has been an ongoing catalog of misfortune,¹,²