Farley D O
Physician Payment Review Commission, Washington, DC 20037, USA.
Adv Ren Replace Ther. 1994 Apr;1(1):24-31. doi: 10.1016/s1073-4449(12)80019-7.
The Medicare end-stage renal disease (ESRD) program has offered financial access to needed health care for ESRD patients, and it has given ESRD providers a reliable source of payment for their services. Total Medicare ESRD expenditures have increased since the inception of the program, due mainly to increased enrollment and changing patient mix. As a result, cost control is a dominant theme of payment policy. This article describes the history of Medicare ESRD financing policy and identifies related service delivery issues including treatment technology, service resources, treatment processes, and patient selection. It also discusses several options available to Medicare for managing the growth of ESRD program costs, including capitation payment methods, control of ESRD enrollment, and payment for erythropoietin treatment. Possible future changes in financing ESRD are identified. With a goal to control costs. Medicare probably will use payment methods to change service mix and reduce use by influencing provider incentives and marketplace competition. Health system reform also may affect ESRD benefits and payments, if the ESRD program is folded into a new financing system. ESRD patients and providers face a challenge of uncertainty during this period of change.
医疗保险终末期肾病（ESRD）项目为ESRD患者提供了获得所需医疗保健的资金渠道，也为ESRD医疗服务提供者提供了可靠的服务支付来源。自该项目启动以来，医疗保险ESRD总支出不断增加，主要原因是参保人数增加和患者结构变化。因此，成本控制是支付政策的一个主要主题。本文介绍了医疗保险ESRD融资政策的历史，并确定了相关的服务提供问题，包括治疗技术、服务资源、治疗流程和患者选择。文章还讨论了医疗保险可用于管理ESRD项目成本增长的几种选择，包括按人头支付方法、控制ESRD参保人数以及促红细胞生成素治疗的支付。确定了未来ESRD融资可能发生的变化。为了控制成本，医疗保险可能会采用支付方法来改变服务结构，并通过影响医疗服务提供者的激励措施和市场竞争来减少使用量。如果ESRD项目被纳入新的融资体系，卫生系统改革也可能会影响ESRD福利和支付。在这一变革时期，ESRD患者和医疗服务提供者面临着不确定性的挑战。
