Nephrol Dial Transplant (2000) 15: 1749-1750
© 2000 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
Clash of cultures: nephrologists meet the market economy
Medical Director, Solid Organ and Cellular Transplantation, Legacy Good Samaritan Hospital, Portland, OR, USA
Introduction
Over the past decade, the delivery of medical care has undergone dramatic changes and the practice of nephrologists in their care of end-stage renal disease (ESRD) patients has been transformed. In the US, approximately 70% of patients are now dialysed in facilities managed and owned by corporate entities. These companies are publicly traded on the stock exchanges and thus have investor-owners. Some of these companies are vertically integrated, such that everything that is purchased such as dialysis machines, dialysers, accessories and tubing are products of the corporation. The dialysis nurses are employees of the corporation. While physicians managing their patients in these units are usually not corporation employees some exceptions exist. It is unclear whether these trends affect the outcomes of nephrology care, but at the very least they make the relationship between the doctors and their
Physician's responsibility for patient outcome
Differences in dialysis practice between countries
Medical decision making: potential conflicts of interest
Performance measures versus doctor–patient relationship
Patient care: an alternative to profit or institutional programmes?
Transparency of market-orientated research
Transparency of physicians' relationship with industry
From a sound cooperation with industry to optimal patient care
Notes
References