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

BACKGROUND/PURPOSE

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.

METHODS

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.

RESULTS

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.

DISCUSSION

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.