New Opportunities for Funding Dialysis-Dependent Undocumented Individuals
New Opportunities for Funding Dialysis-Dependent Undocumented Individuals
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DOI：
10.2215/cjn.03680316
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发表时间：
2017-02-01
影响因子：
9.8
通讯作者：
Raghavan, Rajeev
中科院分区：
文献类型：
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作者：
Raghavan, Rajeev
在美国，估计有6500名肾衰竭的无证透析依赖者的透析费用很高，他们接受的透析护理质量很差，他们的治疗因地区而异。一些地区使用州和配套的联邦基金来支付定期安排的透析治疗，而另一些地区只在紧急危及生命的情况下提供治疗。照顾接受紧急透析的患者的肾病学家面临着一个艰难的道德困境，即决定“当天谁接受透析”。“由于没有获得公民身份的途径，并被排除在联邦市场交易所之外，无证个人的待遇选择有限。为这一人群提供定期透析的一个新机会是通过在交易所购买保险。在交易所购买的计划仍必须遵守2014年《患者保护和平价医疗法案》的规定，该法案禁止保险公司基于先前存在的健康状况拒绝承保。2015年和2016年，在德克萨斯州两个最大的安全网医院系统中，超过100名以前只接受紧急透析的患者获得了场外商业健康保险计划。这些无证患者现在接受定期透析治疗，这改善了他们的护理和生活质量，并为负担过重的医院系统减压。这一选择的长期可持续性尚不清楚。特别值得赞赏的是，决策者顺应社会需求，富有远见，允许向这一大胆的新方向迈进。
The cost of dialysis for the estimated 6500 dialysis-dependent undocumented individuals with kidney failure in the United States is high, the quality of dialysis care they receive is poor, and their treatment varies regionally. Some regions use state and matched federal funds to cover regularly scheduled dialysis treatments, while others provide treatment only in emergent life-threatening conditions. Nephrologists caring for patients who receive emergent dialysis are tasked with the difficult moral dilemma of determining "who gets dialysis that day." Without a path to citizenship and by exclusion from the federal marketplace exchanges, undocumented individuals have limited options for their treatment. A novel opportunity to provide scheduled dialysis for this population is through the purchase of insurance off the exchange. Plans purchased off the exchange must still abide by the 2014 provision of the Patient Protection and Affordable Care Act, which prohibits insurance companies from denying coverage based on a preexisting health condition. In 2015 and 2016, >100 patients previously receiving only emergent dialysis at the two largest safety -net hospital systems in Texas obtained off-the-exchange commercial health insurance plans. These undocumented patients now receive scheduled dialysis treatments, which has improved their care and quality of life, as well as decompressed the overburdened hospital systems. The long-term sustainability of this option is not known. Socially responsive and visionary policymakers allowing the move into this bold, new direction deserve special appreciation.