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U.s. Cost-saving Policy Forces New Kidney Transplant

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http://www.nytimes.com/2009/09/14/health/p...tml?_r=1&hp

Melissa J. Whitaker has one very compelling reason to keep up with the health care legislation being written in Washington: her second transplanted kidney.

The story of Ms. Whitaker’s two organ donations — the first from her mother and the second from her boyfriend — sheds light on a Medicare policy that is widely regarded as pound-foolish. Although the government regularly pays $100,000 or more for kidney transplants, it stops paying for anti-rejection drugs after only 36 months.

The health care bill moving through the House of Representatives includes a little-noticed provision that would reverse the policy, but it is not clear whether the Senate will follow suit. The 36-month limit is one of several reimbursement anomalies — along with inadequate primary care payments and incentives that encourage unneeded care — that many in Congress hope to cure.

Ms. Whitaker, 31, who describes herself as “kind of a nerd,†has Alport syndrome, a genetic disorder that caused kidney failure and significant hearing loss by the time she was 14. In 1997, after undergoing daily dialysis for five years, she received her first transplant. Most of the cost of the dialysis and the transplant, totaling hundreds of thousands of dollars, was absorbed by the federal Medicare program, which provides broad coverage for those with end-stage renal disease.

Despite that heavy investment, federal law limits Medicare reimbursement for the immunosuppressant drugs that transplant recipients must take for life, at costs of $1,000 to $3,000 a month.

Once Ms. Whitaker’s Medicare expired, she faced periods without work and, more important, without group health insurance, which disregards pre-existing conditions. Struggling financially, she soon found herself skipping doses of anti-rejection drugs.

By late 2003, her transplanted kidney had failed, and she returned to dialysis, covered by the government at $9,300 a month, more than three times the cost of the pills. Then 15 months ago, Medicare paid for her second transplant — total charges, $125,000 — and the 36-month clock began ticking again.

“If they had just paid for the pills, I’d still have my kidney,†said Ms. Whitaker, who shares an apartment in the La Jolla neighborhood with her boyfriend, Joseph D. Jamieson. “I’d be healthy, working and paying taxes.â€

The Medicare program is not sure how many of the country’s 100,000 transplant recipients are without insurance for their immunosuppressant drugs. Officials with the National Kidney Foundation said some dialysis patients never put themselves on transplant lists because they fear that they will not be able to afford the drugs.

Clearly we need a system like this to replace the NHS, this is far more cost effective.

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Why does a kidney transplant cost 100,000+ USD? That's a good annual salary. Does it take equivalent to one man year to do this?

Sigh , its an allocation of overheads...

Its like when you take a car down to the mechanic he quotes you £150 labour for a 2 hour job , the mechanic personally does not get £75 he gets substantially less. But overheads such as extortion tax (biz rates) , electricity , heat and rent have to be incorporated into the cost per job.

I'd imagine a hospital to have an enourmous amount of overheads in addition to support staff who bring their own overheads, you can't do surgery in a shed you know.

Its like the Simpsons Dr Nick Riviera , 'ello everybody .......

Or an episode of Quincy ME I saw decades ago where a private surgery kills somebody cus the defib device doesn't work.

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Why does a kidney transplant cost 100,000+ USD? That's a good annual salary. Does it take equivalent to one man year to do this?

That's the US cost, which like all US healthcare is massively inflated. By contrast, the NHS can provide a kidney transplant for about £17,000.

Although the surgery isn't hugely complex, all surgery is necessarily expensive, due to the number of staff involved, equipment, drugs, etc. You may require 2 senior surgeons, anaesthetist, 2 nurses and several assistants to perform the surgery. There is considerable equipment that is very expensive to procure, has limited life span, and requires expensive cleaning and sterilization.

Then you've got the after care - a decent spell in hospital, several days in high dependency care, potentially requiring 1 to 1 nursing 24 hours per day.

Numerous tests in hospital to ensure that the transplant is working correctly - some potentially very expensive (due to the use of very expensive materials - e.g. radioactive Technecium-99m which can cost hundreds of £ per dose).

Then there are the drugs - anti-rejection drugs, antibiotics to prevent infection, anaesthetic drugs etc., once you add the cost of these, particularly the cost of preparing and administering them by injection - you could easily get into costs of several hundred £ per different category.

And then of course, there are the overheads - building costs, capital equipment costs, other staff overheads (e.g. pharmacy, porters, clerical staff).

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Sigh , its an allocation of overheads...

Its like when you take a car down to the mechanic he quotes you £150 labour for a 2 hour job , the mechanic personally does not get £75 he gets substantially less. But overheads such as extortion tax (biz rates) , electricity , heat and rent have to be incorporated into the cost per job.

I'd imagine a hospital to have an enourmous amount of overheads in addition to support staff who bring their own overheads, you can't do surgery in a shed you know.

Its like the Simpsons Dr Nick Riviera , 'ello everybody .......

Or an episode of Quincy ME I saw decades ago where a private surgery kills somebody cus the defib device doesn't work.

Private medicine is no more cost effective than public medicine as private medicine is an effective monopoly/oligoploy.

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Guest DissipatedYouthIsValuable
That's the US cost, which like all US healthcare is massively inflated. By contrast, the NHS can provide a kidney transplant for about £17,000.

Although the surgery isn't hugely complex, all surgery is necessarily expensive, due to the number of staff involved, equipment, drugs, etc. You may require 2 senior surgeons, anaesthetist, 2 nurses and several assistants to perform the surgery. There is considerable equipment that is very expensive to procure, has limited life span, and requires expensive cleaning and sterilization.

Then you've got the after care - a decent spell in hospital, several days in high dependency care, potentially requiring 1 to 1 nursing 24 hours per day.

Numerous tests in hospital to ensure that the transplant is working correctly - some potentially very expensive (due to the use of very expensive materials - e.g. radioactive Technecium-99m which can cost hundreds of £ per dose).

Then there are the drugs - anti-rejection drugs, antibiotics to prevent infection, anaesthetic drugs etc., once you add the cost of these, particularly the cost of preparing and administering them by injection - you could easily get into costs of several hundred £ per different category.

And then of course, there are the overheads - building costs, capital equipment costs, other staff overheads (e.g. pharmacy, porters, clerical staff).

The cost of immunosupressant drugs over here privately is about £60 a month, too.

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Guest DissipatedYouthIsValuable
That ain't gonna break the bank is it.

Not until the for-profit parasite layer gets in on the action.

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I've never saw you post so many articles about the NHS and how VFM it was before your wife's job was potentially under threat.

And she doesn't work for the NHS.

Perhaps my other posts have got lost or the fact there was very little in the press about the NHS / healthcare worth posting.

To provide comprehensive health the only cost effective method is a single govt entity, however it also requires very good management to stop costs from ballooning into the cosmos. Currently we appear to be going beyond Pluto.

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