For-profit dialysis clinics linked to worse patient outcomes and reduced transplant access.
Most people in the United States who need dialysis get their treatment from clinics owned by large for-profit companies. These companies make up nearly 80% of the dialysis market, and just two of them—DaVita and Fresenius—control over 60% of all dialysis centers. While these clinics are supposed to help people with kidney failure stay alive and manage their condition, growing concerns have emerged about how business choices may be affecting patient care.
A recent investigation and years of research have raised red flags. One-third of clinics failed to meet federal performance standards in the past year. Many of these underperforming facilities belong to major for-profit groups. At the same time, people on dialysis in the U.S. are dying faster than those in other developed countries—up to twice as fast, according to some experts.
Between 1998 and 2010, big companies bought out more than 1,200 smaller dialysis clinics across the country. After the takeovers, researchers found changes that raised serious concerns. Staff with less training were brought in to replace more experienced nurses. Each employee was made responsible for more patients, and more people were assigned to each machine. This made treatment more stressful for workers and may have increased risks for patients.
At the same time, there were shifts in how medications were given. One drug used to treat anemia, which is common among dialysis patients, was given out at much higher rates. The drug, called Epogen, was profitable for clinics under Medicare rules at the time. After Medicare changed its payment system in 2011, use of the drug dropped sharply, suggesting that decisions about care may have been driven by money rather than patient need.
Research found that after large companies took over, patients were more likely to be hospitalized. The chances of surviving dialysis also dropped. Even more troubling, patients were less likely to be placed on the waiting list for a kidney transplant. That means fewer patients had a shot at getting off dialysis entirely, even though a transplant is often the best long-term outcome.
Some of the blame falls on the lack of competition. In many areas, patients have only one provider to choose from. Even when there are more than one, barriers like poor health or lack of transportation can make switching clinics nearly impossible. Without any pressure from competitors, companies have little reason to improve how they treat patients.
Experts are calling for Medicare to work more closely with antitrust agencies to review these mergers. Right now, many clinic buyouts happen without much oversight because the individual locations are small and don’t seem to change the market much on their own. But when hundreds of small deals add up, the overall effect can be huge. These changes, even if they are hard to track at the local level, are having a real impact on people’s health.
The story of dialysis in the U.S. is one where business and medicine are deeply connected. While companies argue that their focus is always on safety and care, the numbers suggest otherwise. Patients are getting sicker, dying sooner, and missing out on better options. Meanwhile, clinics continue to grow, collect Medicare payments, and look for new ways to cut costs.
Researchers stress that better rules, stronger oversight, and cooperation between agencies are needed to make sure people with kidney failure are not being overlooked. As things stand now, the current system seems to reward volume and cost-cutting more than it supports life-saving care.
With hundreds of thousands of Americans relying on dialysis to stay alive, the choices made in for-profit corporate boardrooms can carry serious weight. When profits rise while outcomes get worse, it becomes harder to argue that the system is working for the people it’s supposed to serve.
Sources:
Kidney dialysis industry accused of maximizing profits over patients
Big For-profit dialysis companies worsen patient care
Kidney Dialysis Is a Booming Business–Is It Also a Rigged One?
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