Cross-national differences in dialysis rates.

The dialysis treatment rate is more than 50 percent higher in the United States than it is in any West European nation. Relman and Rennie's analysis of this difference in rates raised the possibility that the extra care provided in the United States is unnecessary and is partially attributable to the existence of a private market for renal dialysis services. Their analysis ignores the effect of race on treatment needs in the United States. About 50 percent of the difference observed in rates between the American experience and the European maximum can be attributed to differences in the black/white composition of the populations. Most of the remaining difference in rates appears to be due to European policies that prohibit or severely limit access to dialysis by the elderly and those potential patients with significant medical complications.