Market forces underlie provision of peritoneal dialysis by dialysis facilities
Research Activities, April 2012
For many patients with end-stage renal disease (ESRD), peritoneal dialysis (PD) offers the promise of a clinically equivalent, convenient, and less expensive alternative to hemodialysis (HD), the dominant form of treatment. Whereas HD is performed by clinical staff in a dialysis clinic three times a week, PD patients self-perform dialysis internally via their peritoneal (abdominal) membrane several times daily and only visit the dialysis clinic monthly for maintenance.
Despite the appeal of PD to patients, payers, and providers, PD use in the United States reached 14 percent in 1985 and declined to 6.2 percent by 2008. A new study shows that market forces may be the driving force behind this. It examined market factors associated with the provision of PD in dialysis facilities between 1995 and 2003 and found that facilities with competitive dialysis markets and/or markets with greater spatially concentrated PD services were less likely to provide PD. New facilities were less likely to offer PD than existing facilities. Neither disease trends nor patient characteristics associated with PD use explained the provision of PD.
These findings suggest that PD may not be available to all patients who would benefit from it and there may be insufficient demand, economies of scale, or incentives for facilities to provide PD, note the study authors. Their findings were based on data from 4,436 Medicare-participating outpatient dialysis facilities, of which between 44 and 50 percent offered PD in the period 1995-2008. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00032).
See "Longitudinal analysis of market factors associated with provision of peritoneal dialysis services," by Virginia Wang, Ph.D., Shoou-Yih D. Lee, Ph.D., Uptal D. Patel, M.D., and others in Medical Care Research and Review 68(5), pp. 537-558, 2011.