Chronic renal failure

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The author briefly describes the Medicare End-Stage Renal Disease Program, which has covered dialysis and kidney transplants for 12 years at a cost of $2 billion for 70,000 patients as of 1983. This program is used to illustrate the problems of patient selection for expensive treatment; the usefulness of self care in the home setting; the effects of funding on (a) the choice of treatment and the number of patients treated, (b) reimbursement and modalities of treatment, and (c) health care providers as well as the health care equipment supply industry; and the problems of collecting data on a national basis. Many of these lessons are important in view of the trend toward increasing use of home care in other fields of medicine.