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Safety-net care for maintenance dialysis in the United States

Journal of the American Society of Nephrology Jan 31, 2020

Erickson KF, Shen JI, Zhao B, et al. - Given that most American patients suffering from ESKD become eligible for Medicare by their fourth month of dialysis, but some never do, and since there has been a lack of information regarding where patients with limited health insurance receive maintenance dialysis, researchers selected patients starting maintenance dialysis (2008–2015) from the US Renal Data System, describing patients as “safety-net reliant” if they were uninsured or had only Medicaid coverage at dialysis start and were not eligible for Medicare by the fourth dialysis month. They assessed four dialysis facility ownership classes as per for-profit/nonprofit status and ownership (chain vs independent). Findings revealed the receipt of care at for-profit/chain-owned facilities in most patients who were safety-net reliant, however, these patients were disproportionately cared for at nonprofit/independently owned and hospital-based facilities. Safety net–reliant populations may be influenced by the ongoing loss of market share of nonprofit/independently owned outpatient dialysis facilities.
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