Barriers to providing optimal dialysis care for undocumented immigrants: Policy challenges and solutions.
Barriers to providing optimal dialysis care for undocumented immigrants: Policy challenges and solutions.
复制标题
为无证移民提供最佳透析护理的障碍：政策挑战和解决方案。
DOI：
10.1111/sdi.12846
复制
发表时间：
2020
影响因子：
1.6
通讯作者：
Cervantes,Lilia
中科院分区：
文献类型：
--
作者：
Welles,ChristineC;Cervantes,Lilia
患有终末期肾病(ESRD)的非法移民获得血液透析的机会在美国各地差异很大，并且高度依赖于州政策。一些州已经制定了政策，为非法移民提供标准透析保险，而另一些州则不提供保险。生活在一些不提供保险的州的患者依赖于通过《紧急医疗和现行劳工法》获得的联邦紧急保险。然而，这项法案要求患有急性生命危险的患者才能接受透析，这就是所谓的“紧急纯血液透析”(EoHD)。由于EoHD要求患者出现危及生命的情况，依赖EoHD的患者会出现衰弱的身体症状和心理社会痛苦。接受EoHD的非法移民的死亡率也比接受标准血液透析的人高得惊人。此外，与标准透析相比，EoHD导致更高的卫生保健利用率和更高的卫生保健成本。因此，EoHD代表着一种非常低价值的护理实践，以更高的成本提供不合标准的护理。迫切需要改变政策，为无证移民提供ESRD标准的护理；即每周三次标准血液透析或腹膜透析。
Access to hemodialysis for undocumented immigrants with end stage renal disease (ESRD) is widely variable across the United States and highly dependent upon state policy. Some states have enacted policies to provide coverage for standard dialysis to undocumented immigrants, while other states do not provide coverage. Patients living in some states which do not provide coverage rely on emergency federal coverage through the Emergency Medical Treatment and Active Labor Act. However, this act requires that patients present with an acute, life‐threatening condition in order to receive dialysis, which is then referred to as “emergency‐only hemodialysis” (EoHD). Because EoHD requires patients to present in life‐threatening condition, patients who rely on EoHD suffer from debilitating physical symptoms and psychosocial distress. Undocumented immigrants who receive EoHD also have staggeringly higher mortality rates than those who receive standard hemodialysis. Moreover, in comparison with standard dialysis, EoHD results in greater health care utilization and higher health care costs. Therefore, EoHD represents a very low value care practice, providing substandard care at a greater cost. Policy change is urgently needed to provide undocumented immigrants with ESRD access to the standard of care; that is, three‐times weekly standard hemodialysis or peritoneal dialysis.