THE SENATE Finance Committee has completed hearings on a measure already approved by the House of Representatives that would enable thousands of Americans with severe kidney disorders to receive treatment in their homes. The "home dialysis bill," now awaiting full Senate action, expands federal payments to include persons who choose to have home dialysis, the medical procedure that removes impurities from the blood. As it now stands, the Medicare program covers all of the costs for Medicare patients as well as people under age 65 needing dialysis - provided that the treatment is received in hospitals or clinics. On the other hand, persons who get pretty much the same treatment at home receive no government assistance, even though there are comparable costs involved.
More than 45,000 Americans suffer from kidney failure - or "end stage renal disease," as it is medically known - and there are almost 10,000 new patients every year. Patients must have dialysis on the average of three times a week, at a cost per-patient of from $15,000 to $30,000 every year. Since the government foots almost all of the bill, in 1978 more than $900 million will be paid to hospitals and centers for dialysis treatment. Treatment at home would cost considerably less ($8,000 to $12,000 a year) since the personnel, rent and other overhead costs associated with treatment centers would be eliminated.
There are other advantages to home dialysis. For example, home treatment allows patients flexibility in scheduling the 4 or 5-hour procedure and lessens the interruption to jobs and other activities. And because there is usually only one person in a household who uses the equipment, there is far less chance of a patient's contracting contagious diseases - a serious problem in dialysis centers. Critics of home dialysis contend it results in a higher risk to the life of the patient than does treatment in centers. Studies indicate, however, that the mortality rate for patients who have home dialysis is just about one-half that of those treated in centers. Opponents also question the fairness of the government's spending on this type of treatment when comparable assistance is not available for treatment of many other comparable illnesses.
We think that the Senate should approve this measure; it eliminates the main disparity in the way federal money can be spent for dialysis treatment. As for just how far the government should go in helping terminally ill patients pay for treatment, that is a separate and quite complicated question currently being examined by the Congress and the administration. But money is not the major consideration here. Costs might be a little lower since dialysis at home is less expensive than in centers; or it might be a little higher if more people take advantage of it. In any case, postponing this legislation until the larger financial questions are resolved would only harm those who can now be helped.