Using a Dialysis Need-Projection Model for Health Planning in Massachusetts

More than $5.1 million in unnecessary kidney dialysis facilities, equipment, and staff has been saved in Massachusetts during the past two years as a result of a model used by the Massachusetts Department of Public Health (DPH) to predict future need for dialysis in the state. These savings constitute 63% of the total proposed capital and manpower costs for the two-year period, accomplished mainly through the denial of 59% of the 163 requests for new dialysis stations.In addition to substantial savings in construction, new equipment and staff, the denial of these requests had several other benefits: Existing facilities have operated at more efficient levels, with lower per-patient treatment costs. Through the restriction of center dialysis supply, more patients were encouraged to utilize home dialysis. Greater reliance on home dialysis could translate into an annual savings of at least $2.6 million and an additional 333 person years as a result of the enhanced life expectancy for home dialysis patients. The need model has also been useful in more equitably distributing dialysis resources to regions in Massachusetts which have previously been underserved. The model has been successful in predicting the need for kidney dialysis services to within 1% of actual demand. Versions of the model are now being used by the US Department of Health and Human Services and by the six Health Systems Agencies of Massachusetts. Similar models can also be used to forecast the need for other types of specialized medical care technology, such as cardiac pacemakers.