A large amount of patients present to our county ER with a chief complaint of needing dialysis. These patients are undocumented residents that can only receive compassionate dialysis (meaning they only can receive it when they get very ill, not on a schedule). I wondered, why can't these patients receive dialysis on a scheduled basis and wouldn't it be more cost effective and better for the patients to receive scheduled dialysis rather than showing up at an ER every time they needed dialysis?
Patients that are US citizens with End Stage Renal Disease qualify for Medicare or Medicaid through the End Stage Renal Disease Program that was enacted in 1973. However, undocumented residents cannot received any federal funding for dialysis. In 1986 as a part of the Consolidate Omnibus Budget Reconciliation Act (COBRA), the use of federal funds for covering undocumented residents for non-emergency services, like dialysis was prohibited. Some states use state funds to provide for scheduled dialysis (California, Massachusetts), while other states (Texas) do not. So patients in the states that do not provide funds for scheduled dialysis (like Texas), are left to present to the ER multiple times a week to determine if they are ill enough to receive dialysis. The annual cost of scheduled hemodialysis is about $72,000. However, this cost of compassionate/emergency dialysis is more than $200,000 annually. Compassionate dialysis also is bad for the health of the patient. It has been noted that when comparing scheduled dialysis to compassionate dialysis, the later results in more ER visits, more hospitalization.
In my opinion it would be more cost effective, better for the patient, and better for community as a whole if there was universal coverage for patients with End Stage Renal Disease so that they may receive scheduled dialysis. Over the next few years, millions of people will be eligible for health insurance. Because of the existing shortage of primary care doctors, as more people receive health insurance, it is likely that more people will be trying to see primary care doctors. The people that can’t get an appointment with a primary care doctor will likely go to the ER if they need to for treatment. ER overcrowding is already a serious issue and will likely get worse. It likely would help alleviate some of the strain on the ER by providing undocumented citizens scheduled dialysis so they don’t have to come to the ER multiple times in a week in order to try to get dialysis.
More information can be found in this recent New England Journal of Medicine article--Raghavan, R., Nuila, R., Survivors-Dialysis, Immigration, and U.S. Law, NEJM 2011;364:23: 2183-85.