201303 Policy Implications: Eroding Access to Dialysis Treatment for the Uninsured in the State of Alabama

Tuesday, November 10, 2009

Valerie A. Yeager, MPH, MPhil , South Central Center for Public Health Preparedness, University of Alabama at Birmingham School of Public Health, Birmingham, AL
Andrew C. Rucks, PhD , Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, AL
Denyse Thornley-Brown, MD , Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL
Arlene Carrasquillo, MSW , Center for Research in Women's Health, University of Alabama at Birmingham, Birmingham, AL

Uninsured patients with End Stage Renal Disease (ESRD) have limited and uncertain access to chronic dialysis treatments. Recent federal legislation requires that Medicaid cover the costs of emergency dialysis for the uninsured. Eleven state emergency Medicaid programs fund outpatient chronic dialysis for the uninsured, regardless of citizenship status, however in Alabama some uninsured patients rely on sporadic emergency department visits to receive dialysis. Studies have shown that emergency dialysis administered through emergency departments is more costly; and lack of access to chronic dialysis results in worse patient outcomes, thereby resulting in overall higher costs to the health care system. No estimates exist regarding the need for chronic dialysis or the costs incurred to the health care system among uninsured ESRD patients in the state of Alabama.


We conducted a mail survey of Alabama nephrologists (n=126). The questionnaire assessed the extent to which nephrologists encountered uninsured ESRD patients and an estimate of how many were undocumented immigrants. Respondents were also asked about the frequency that uninsured ESRD patients were successfully admitted into an ambulatory dialysis program.


This is an ongoing study. Analyses will be completed by June 2009. Results will offer an approximate measure of the number of uninsured ESRD patients without access to chronic dialysis in Alabama last year.


An estimate of the unmet needs of ESRD patients requiring chronic dialysis in the state of Alabama may provide valuable information for hospital decision-makers and state policy-makers.

Learning Objectives:
1.Describe the need for chronic dialysis care among the uninsured in the state of Alabama 2.Discuss possible solutions to the dilemma of increased costs and co-morbidities among those accessing dialysis irregularly through emergency departments

Keywords: Access to Care, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a public health researcher and doctoral student and I have led this study and am processing and analyzing the data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.