For-Profit Dialysis Centers Might Provide Less Quality Care than Not-For-Profit Centers, Study Says

Private, for-profit kidney dialysis centers may provide lower-quality care than private, not-for-profit kidney dialysis centers, according to a new study in the Nov. 20 Journal of the American Medical Association, the Los Angeles Times reports. For the study, researchers from McMaster University in Ontario, Canada, and the University of Buffalo pooled results from eight studies that tracked more than 500,000 patients at U.S. dialysis centers from 1973 through 1997 (Mestel, Los Angeles Times, 11/20). Researchers found an 8% higher death rate among kidney failure patients receiving dialysis at for-profit centers, amounting to about 2,500 additional deaths each year. Study co-author Dr. P.J. Devereaux said that the "economic realities" at for-profit centers could explain the higher death rates. He said that because for-profit centers need to make money, they may employ cost-cutting measures, including reduced staffing levels and shortened dialysis time for patients (Tanner, AP/Atlanta Journal-Constitution, 11/20). Study co-author Dr. Holger Schunemann said the findings suggest that "one should seriously rethink whether for-profit health care should be delivered or allowed" (Los Angeles Times, 11/20).

Taking Issue with the Findings
Some physicians "strongly criticized" the findings, saying that the study was based on outdated practices, the AP/Atlanta Journal-Constitution reports(AP/Atlanta Journal-Constitution, 11/20). Phillip Held, founder of the University Renal Research and Education Association, said, "It's kind of a stretch. Even if what they say is true -- and I'm not very convinced by what they report -- it's history. It borders on ancient history." Held cited several recent studies that found no significant difference in the quality of care between for-profit and not-for-profit dialysis centers (Los Angeles Times, 11/20). Dr. David Warnock, president-elect of the National Kidney Foundation, said, "There is no reason to doubt the validity of these findings (as being) relevant to that time period, but I am very uncomfortable applying these results to 2002" (Ricks, Contra Costa Times, 11/20). Dr. Paul Scheel, a Johns Hopkins University kidney specialist, called the findings "absolute rubbish," saying, "It tells you how dialysis was practiced in the 1980s and '90s and has absolutely zero relevance today" (AP/Atlanta Journal-Constitution, 11/20). The study is available online.