guest
Guest
Posted: Sat Jan 07, 2006 5:44 pm Post subject: so what?
--------------------------------------------------------------------------------
Population doubled but costs tripled. So costs exceeded the growth in patients, so...??? That is true across the board in the healthcare industry. Costs per patient have risen.
Deaths exceeding population? Again....so? Older and sicker people with greater co-morbidities are receiving dialysis and this will continue to increase and death rate will continue to outpace growth rate? Dialysis is not killing people, but rather the co-morbidities that landed them there. Our society is fatter and unhealthier every passing year and these people will not fare as well on dialysis as they might have years ago. These statistics will continue.
The dialysis patient is not paying any more for this service. Who are you kidding? Yet the bitching and moaning never stops. Yeah, let's pay for even more dialysis. We can't get a lot of these mopes to even show up three times a week and run their full time, yet we want more? You're in liberal dream world.
**********************************************************************************
plugger
Joined: 11 Jan 2003
Posts: 226
Posted: Sun Jan 08, 2006 1:29 am Post subject: bull
--------------------------------------------------------------------------------
No, I'm in a world backed up by stats and eyewitness accounts - you seem to be in one you make up as you go along, based on assumptions (always dangerous to assume). As for your older, sicker, fatter assumption - here is what a couple of sources have to say about that:
"These clinical outcomes are reflected in the mortality rates of dialysis patients which, according to the USRDS, in 2000 were 24.0% in the United States as compared to 11.0% in France and 9.7% in Japan. Although mortality rates are influenced by many factors, including the relative risk of death determined by considering age, overall health and other variables, a study published in 1994 indicates that, even after adjusting for relative risk of death, the mortality rate in the United States was twice that of Japan. While the exact cause of this difference in mortality rates has not been established, the USRDS has determined that mortality in patients is highly correlated to the dose of dialysis delivered to patients. In general, the dose of dialysis depends on the performance of the artificial kidney, patient size and the duration of treatment."
http://www.aksys.com/therapy/esrd.asp "There has been growing concern about the epidemic of obesity in the United States and the potential adverse implications of an "expanding" population (1-3). However, the effect of adiposity on morbidity and mortality with respect to end-stage renal disease (ESRD) is uncertain. Divergent associations have been reported between survival and adiposity in transplant recipients and dialysis patients. While several studies have suggested that outcomes after kidney transplantation are adversely affected by increasing adiposity (4-7), others have shown that dialysis patients with higher body mass index (BMI; in kg/m2) enjoy a survival advantage even in the BMI range that is ordinarily considered harmful (8-14)"
http://www.ajcn.org/cgi/content/full/80/2/324 I don't enjoy believing as I do, however I've been forced to some sad conclusions; Arlene would be the first to tell you I wasn't exactly on board with all this when I first visited this organization. You are right though that dialysis isn't killing people - but the lack of seems to be. And yes, healthcare costs have risen everywhere - we are getting ripped-off across the whole spectrum, but I would rather leave that one alone for now.
**********************************************************************************
guest
Guest
Posted: Sun Jan 08, 2006 12:17 pm Post subject:
--------------------------------------------------------------------------------
Studies, studies, studies, with uncertain, "we're not sure", and different conclusions. I just bought a house and I picked my own appraiser, a well thought of guy. First question he asked me was, "what kinda figure you looking for here". The point is this..if you commissioned me to do a study and suggested what finding you were looking for, I could find it for you depending on where our mutual interests lie.
How about a little common sense without the studies. Thin people live longer than fat people. Japan is a fitter, more compliant society than the US. People are healthier when the START dialysis and maybe they don't dialyze everyone who the family wants dialyzed over there as we do here ,even if they do have 9 toes in the grave. There's your study. Comparing us to other countries is an exercise in futility.
More dialysis? How do you pay for it, and more importantly, how do you get a majority of dialysis patients who don't even want 12 hours a week as it is to go for it?
**********************************************************************************
plugger
Joined: 11 Jan 2003
Posts: 226
Posted: Sun Jan 08, 2006 3:45 pm Post subject: study this
--------------------------------------------------------------------------------
Oh, let?s see what my common sense tells me. Do I take the word of some anonymous poster on the internet who?s common sense seems to include a loathing for the people he works on, or people who have actually studied the situation ? sorry, but I?ll take the people who have studied the situation every time. You can knock the studies all you want, but when you include it with many of the stories I?ve heard and read they make a powerful argument.
My common sense tells me too fat and too thin are bad when taken to extremes; the thing I?m getting from the study I posted is a little more junk-in-the-trunk for a dialysis patient may not be such a bad thing ? I can live with that. My common sense also tells me we aren?t so different from the Europeans and if people here got the same treatment they got over there we just might have something closer to the same mortality stats. My common sense also tells me longer, more frequent dialysis would go a long ways in bringing down the mortality rate and people should have that choice. HR3096 would allow that choice and believe the good doctors behind that bill who claim it would actually bring down costs due to less hospitalization, drugs, and better health of the patients.
**********************************************************************************
Marty1
Guest
Posted: Sun Jan 08, 2006 5:02 pm Post subject: Patients
--------------------------------------------------------------------------------
To get patients to do more than 12 hrs a week they need to be informed and educated by nephrologist who have seen the results from patients on daily and nocturnal dialysis. The cost will be made up with less money spent on hospitalizations. For someone who seems to think they know something it is obvious you haven't done much research on what the studies on mortality point to. It points to the fact that patients in other countries are living longer because they normally get more dialysis. France has always done 8 hr treatments 3x a week. You really should do a little research because it appears that your posts are based on your assumptions that have been proven wrong in recent years. As the education gets out more and more home programs are being set up so patients can get enough dialysis to live longer and live well. Hi Plugger long time.
**********************************************************************************
guest
Guest
Posted: Sun Jan 08, 2006 6:34 pm Post subject: Marty
--------------------------------------------------------------------------------
Marty, I have a lot of respect for you and your insight. You're way, way off on this though. If you think you can get people in the United States to take one full day per week and spend it on dialysis, well....
You think information could sway them? Trust me, you could have a crystal ball which shows video of them living a longer and healthier life and they won't do it. This ain't France.
I may be making assumptions but, by the same token, you cannot take you own personal experience and extrapolate it to the entire dialysis population. My assumptions are not necessarily wrong just because some user-friendly study doesn't back them up. Some observations made during years of working in this industry have shown me some truisms which no studies will disprove.
**********************************************************************************
guest
Guest
Posted: Sun Jan 08, 2006 6:45 pm Post subject: Plugger
--------------------------------------------------------------------------------
/>
Plugger...whatever man. My anonymity means that you have never met me. I guess then, that you may be making a few assumptions yourself. Speaking of anonymity, is Plugger the name on your birth certificate?
Don't puff your chest out over how brave you are. When you post your name and address, only then you will you be less anonymous than I.
**********************************************************************************
plugger
Joined: 11 Jan 2003
Posts: 226
Posted: Mon Jan 09, 2006 8:13 am Post subject: Sorry if you felt threatened
--------------------------------------------------------------------------------
I wasn't pointing out how brave you were or not - just less credible from my perspective. Anyway I think it would be foolish for either one of us to post our names and addresses in this sort of forum.
But getting back to your argument that this isn?t France, you seem to base your conclusions on negative stereotypes you have of people. If that held true, you would think the French would be the last people to be compliant, after all they are supposed to eat a lot of fatty food, smoke, and be quite obstinate ? I guess stereotypes don?t always hold up. I don't know how many people would be willing to do daily or more frequent dialysis, slow nocturnal, or however they do it in France and Japan - but I do know most don't seem to have the choice now.
But hey, maybe I did make a bad assumption about how you feel about the people you work with - I do hope it isn't true. If I'm wrong, I apologize.
And it is great to hear from you too Marty! I hope things going well for you.
