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To the Editor.— From the outset, implementation of the Medicare End-Stage Renal Disease (ESRD) Program has been complicated by problems of inadequate or inaccurate information of policies and progress. Considerable attention has been given to recent articles and testimony suggesting that the total costs have far exceeded expectations and that the Department of Health, Education, and Welfare failed to recognize or support in-home dialysis and transplantation as the preferable, and least costly, treatment alternatives. The following information will record that these suggestions are incorrect. In late 1972, before implementation of Section 2991 of the Social Security Amendments of 1972 began, a comprehensive analysis of the cost and survival implications of various dialysis and transplantation alternatives, including life-cost tables factoring multiple permutations of incidence, mortality, treatment pathway, and patient distribution, was developed by the Office of the Assistant Secretary for Health. Compared with the actual experience for the first five years,
JAMA – American Medical Association
Published: Jan 19, 1979
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