Details

Autor(en) / Beteiligte

• Melanson, Taylor Andrew

Titel

The Impact of Recent Policy Changes on the Treatment of Patients with Kidney Disease in the U.S

Ort / Verlag

ProQuest Dissertations & Theses

Erscheinungsjahr

2018

Link zum Volltext

Quelle

ProQuest Dissertations & Theses A&I

Beschreibungen/Notizen

• In the United States, chronic kidney disease is a large, and growing public health concern that disproportionately affects minorities and individuals with low socioeconomic status. While Medicare covers patients who have progressed to end-stage renal disease, coverage prior to ESRD is critical to improving patient outcomes. Medicaid expansion has extended coverage to millions of Americans and presents a significant opportunity to improve the care of CKD patients. Guidelines for the care of these patients have changed over time and it is important to understand how insurance coverage interacts with such changes. Once patients progress to ESRD, the preferred treatment is a living donor kidney transplant. Both Medicaid expansion and the recently implemented Kidney Allocation System have potential to significantly alter access to living donor kidney transplantation. This dissertation seeks to illuminate the interactions between guidelines, changes in insurance coverage, and organ allocation policy, and how these factors impact care of patients with CKD. The three essays of my dissertation examine: the impact of Medicaid expansion and guideline changes on pre-ESRD nephrology care; the impact of Medicaid expansion on rates of living donor kidney transplantation; and the impact of Medicaid expansion and the new Kidney Allocation System on racial disparities in living donor kidney transplantation rates. The findings of this dissertation provide evidence that, although improving coverage for low socioeconomic status individuals is an important step towards improved access to care, it is not sufficient to ensure that all patients are receiving equitable treatment. Given the large downstream costs associated with poorly treated CKD, it is important that efforts are made to improve preventive care and to encourage living donation. The findings also suggest that improving access to deceased donor kidney transplantation for minorities may have inadvertently worked to funnel minorities to suboptimal care. Policies targeting patients with CKD need to be carefully considered within the framework of existing health care policy to ensure that as we increase access for vulnerable populations we do not further disadvantage them by discouraging them from seeking optimal treatment.