More Deaths In For-Profit Dialysis Centers
2,500 More Die Each Year Than In Non-Profit Facilities
Nov. 19, 2002 -- Thousands of kidney patients each year die too soon in U.S. for-profit dialysis centers, Canadian and U.S. researchers find. Pooled data from eight studies show that patients in for-profit centers have an 8% higher yearly risk of death than patients in non-profit facilities.
Why? For-profit centers cut corners on patient care to make money, according a controversial report in the Nov. 20 issue of the Journal of the American Medical Association.
"People are paying with more dying," lead author P.J. Devereaux, MD, tells WebMD. Devereaux, a cardiologist at McMaster University, Toronto, Ontario, notes that the Canadian government is now debating whether to allow for-profit medical centers.
Last May, Devereaux and colleagues found that patients in private, for-profit U.S. hospitals die 2% more often than patients in private non-profit hospitals.
"For-profit facilities have to generate returns for shareholders and they have to pay taxes; some 10-15% percent of their income goes to these costs," Devereaux says. "So they have to find new efficiencies or just cut the quality of care. That is exactly what they have done. There just isn't that much inefficiency, so it is resulting in a cut in quality of care. We all want to avoid that for our loved ones, for our patients, and for our neighbors."
The dialysis report looks at eight studies of privately owned dialysis centers. Six of the studies found significantly more deaths in the for-profit centers. One found a trend toward more deaths in for-profit centers ; only one study showed a trend toward fewer deaths in for-profit centers. When all eight studies were taken together, the for-profit centers had 8% more annual deaths. According to current estimates, some 20-25% of U.S. dialysis patients die each year.
Currently, three in four U.S. dialysis centers run on a for-profit basis.
"Over time, the private for-profits are taking over, so there has to be money in it," Devereaux says. "These two studies have made me very wary of having a healthcare system that has a focus on making money from people's illness instead of a focus on caring for ill people."
The studies analyzed by Devereaux's team looked at dialysis-center data from 1973 through 1997. That's a fatal flaw, according to David G. Warnock, MD, director of nephrology at the University of Alabama, Birmingham, and president-elect of the National Kidney Foundation.
Warnock doesn't doubt that the findings are true for that time period. But he says things are much different today.
"There has been major consolidation in the dialysis industry such that the for-profit chains -- FMC, GAMBRO, DeVita, and RCG -- now 'control' the great majority of U.S. dialysis patients," Warnock tells WebMD. "There is also a large 'non-profit' chain -- DCI -- which is not appreciably different than the others. Many of the distinctions described in the article have been blurred."