Profit-making in the treatment of chronic kidney disease: Truth and consequences

Many have speculated that the quality of dialysis care differs for patients treated in for-profit and not-for-profit facilities. In 1999 we published a study that demonstrated poorer survival and lower rates of listing for re nal transplant for patients in for-profit rather than not-for-profit, frees tanding centers. While these findings generated substantial discussion, few have commented on their implications. In this article we first discuss pot ential sources of bias that could impact on the study's results and place t he findings in context. We conclude that these disparities are likely to be real, as they are consistent with theorized differences between for-profit and not-for-profit health care organizations and with other evaluations of dialysis facility ownership. We then discuss several policy options for ad dressing the quality differences we identified. Reducing the outcome discre pancies will not be easy. Upon considering several policy alternatives, we conclude that a widespread effort to link processes of dialysis care to pat ient outcomes is best suited to reduce the quality differences between for- profit and not-for-profit dialysis units and improve outcomes in both types of facilities.