In 2010, more than 20 million Americans had chronic kidney disease (CKD). As documented by the United States Renal Data System (RDS), the incidence of CKD has increased from 12.3% of the general population in 1994 to 14.0% in 2010. CKD can lead to kidney failure or end-stage renal disease (ESRD). The only treatment options for ESRD are dialysis or transplant. According to the National Institute for Diabetes and Digestive and Kidney Diseases, from 1980 through 2009 the prevalence rate for ESRD increased nearly 600%. The cost of clinical dialysis for Medicare patients alone was $23.6 billion in 2010. However, the national financial impact and the need and availability of transportation to dialysis treatments have not been quantified.
Dialysis services are provided primarily by large, for-profit corporations. These corporations do not provide the transportation services that many of their clients require; rather they rely on publicly subsidized transportation. While some people choose to drive to and from their dialysis sessions, doing so presents a number of health and safety risks. A recent report by Ride Connection emphasized the challenge faced by our nation when it stated, “The growth in incidence of end-stage renal disease and the decreased mortality rates in this population creates increased burden on a transportation system that was not designed to accommodate life sustaining treatment trips.” Some transportation providers have been forced to deny transportation requests to dialysis while other providers have denied other transportation requests in order to accommodate increased demand for transportation for dialysis. These problems are further compounded in rural communities because there are few dialysis treatment facilities.
The objectives of this research are to quantify the current and projected demand and associated costs of transportation for kidney dialysis in the United States and identify current effective practices and new strategies for funding and providing transportation for dialysis. The research should address a number of important areas and answer the critical questions presented in the Request for Proposal. This research should consider and address differences that affect transportation for kidney dialysis in urban and rural areas.