Unequal access to cadaveric kidney transplantation in California based on insurance status

Objective. To assess the impact of insurance status on access to kidney tra nsplantation among California dialysis patients. Study Setting. California Medicare and Medicaid dialysis populations. Study Design. All California ESRD dialysis patients under age 65 eligible f or Medicare or Medicaid in 1991 (n = 9,102) took part in this cohort analyt ic study. Data Collection. Medicare and California Medicaid Program data were matched to the Organ Procurement and Transplantation Network Kidney Wait List file s. Principal Findings. Only 31.4 percent of California Medicaid dialysis patie nts were placed on the kidney transplant waiting list compared to 38.8 perc ent and 45.0 percent of dually eligible Medicare/Medicaid and Medicare pati ents, respectively. Compared to the Medicaid population, Medicare enrollees were more likely to be placed on the kidney transplant waiting list (adjus ted Relative Risk [RR] = 2.10, Confidence Interval [CI] 1.68, 2.62) as were dually eligible patients (RR = 1.54, CI 1.24, 1.91). Once on the waiting l ist, however, Medicare enrollment did not influence the adjusted median wai ting time to acquire a first cadaveric transplant (p >.05). Conclusions. California dialysis patients excluded from Medicare coverage, who are disproportionately minority, female, and poor, are much less likely to enter the U.S. transplant system. We hypothesize that patient concerns with potential subsequent loss of insurance coverage as well as cultural an d educational barriers are possible explanatory factors. Once in the system , however, insurance status does not influence receipt of a cadaveric renal transplant.