End-Stage Renal Disease, 1978

On July 1, 1973, Public Law 92-603 inaugurated the first disease-specific federal health care program in the United States by implementing the Medicare End-Stage Renal Disease (ESRD) Program. This legislation was introduced by Congress with the best of intentions, but with insufficient consideration of its implications.¹ As a result, the ensuing five years have seen increasing concern over the implementation, cost, and control of the ESRD program. The number of patients treated has increased from 12,000 in 1973 to more than 40,000 in 1978. There has been a doubling of the number of dialysis facilities during the last five years. An elaborate system for planning has been established, involving 32 ESRD network coordinating councils, health systems agencies, and Department of Health, Education, and Welfare (DHEW) regional offices, and there is a similar system for review of quality of care utilizing medical review boards and Professional Standards Review Organizations. Concern