Nov. 19, 2002
Statement by Sidney M. Wolfe, M.D., Director, Public Citizen’s Health Research Group,Concerning JAMA Study on the Dangers of For-Profit Dialysis
There are two clearly unique attributes of the United States’ health care system that distinguish it from those in all other developed countries. First, there are more than 41 million people in this country who do not have health insurance, almost one out of every six people. Related to this steadily worsening problem of the uninsured is the second unique attribute of our system: an unprecedented amount of for-profit health services. In no other country in the world is there more than a shadow of the amount of for-profit health services being delivered in this country, such as nursing homes, hospitals, HMOs and dialysis centers – the subject of the paper being published tomorrow in the Journal of the American Medical Association (JAMA). The study was done by researchers Dr. Gordon Guyatt of McMaster University Medical School and Dr. Holger Schunemann of the University at Buffalo – both here today – and others, including Dr. P.J. Devereaux of McMaster University.
A study by researchers from Harvard Medical School and Public Citizen, published in the JAMA three years ago, found that for-profit HMOs scored lower on all 14 measures of quality of medical care than not-for-profit HMOs. In for-profit plans, toddlers and adolescents were 12 percent less likely to get immunizations; women were 8 percent less likely to receive mammograms, 6 percent less likely to get early prenatal care, 5 percent less likely to get postpartum checkups and 10 percent less likely to get pap smears. Twenty-seven percent fewer diabetics got the eye care they needed to prevent blindness, and heart attack patients were 16 percent less likely to get life-saving beta blocker drugs. In that study, care for the sickest patients – diabetics and heart attack survivors – suffered most in for-profit plans. The McMaster study confirms that the most vulnerable – in this case patients with end-stage kidney disease – are significantly more likely to die when for-profit dialysis centers provide their care.
Since 1989, the number of uninsured has increased from 33 million to 41 million. The push for profit is driving down quality, demoralizing doctors and nurses, discouraging research and teaching, and, as shown in the study being discussed here, causing the deaths of many people each year. To make matters even worse, health costs are again rising extremely rapidly. It is time to reconsider non-profit, single-payer, national health insurance and eventually, the return to a not-for-profit system of delivering health services.