Medicare's end-stage renal disease program: Current status and future prospects

The twenty-five years of the end-stage renal disease (ESRD) program have be en characterized by remarkable clinical achievements, wh ich have prolonged and improved the quality of life for thousands of patients. As the program enters the next millennium, it faces considerable challenges: As the numbe r and acuity of patients increase, the availability of trained nephrologist s will decrease, and total costs will continue to rise. Policymakers will n eed to work closely with the renal professional and patient communities to develop creative approaches to delivering and financing ESRD care that is o f the highest quality, yet is affordable.