Two companies control majority of dialysis market, study says By HPN Staff Just two healthcare firms account for almost 80% of the market for dialysis treatments, which are a major source of spending across both the Medicare and Medicaid programs, according to a new study. A team of researchers led by Duke University studied ownership data for dialysis clinics between 2005 and 2019 and found the two largest chains — DaVita and Fresenius — had grown their combined market share from 59.1% to 77.1% during that time. The researchers also found that the costs of dialysis — a critical treatment for patients suffering kidney failure — and the compensation for senior medical staff was higher in markets dominated by either one of these two large chains. “During this period, markets with only one large chain had $495.08 higher commercial prices for outpatient hemodialysis and $564.56 higher medical director compensation per patient compared to markets without large chain facilities,” the researchers wrote in JAMA Health Forum, a scientific journal affiliated with the American Medical Association. Why it matters Critics of the dialysis industry may seize upon the research findings to support calls for increased regulation of the sector, including through antitrust laws. In May, a union-sponsored health plan filed a federal lawsuit against Davita and Fresenius, alleging the two companies had agreed not to compete against one another in key markets in order to keep dialysis payments artificially high. In response, Davita issued a public statement calling the allegations in the lawsuit “baseless” and promising the company would “defend against [the lawsuit] vigorously,” according to Reuters. Previous mergers and acquisitions within the dialysis industry have also caught the attention of the Federal Trade Commission, which enforces the nation’s antitrust laws. “Growing consolidation in the dialysis industry has raised concerns about market power and the potential need for antitrust enforcement, but a lack of data previously prevented a systematic analysis of these issues,” the Duke University researchers wrote in JAMA Health Forum. Concerns about the cost of dialysis at larger clinics may renew interest in promoting at-home treatments and kidney transplants. The bigger picture During the first Trump administration, federal officials noted that 12% of kidney patients receive at-home treatment in the U.S., which is significantly lower than in many other parts of the world. By comparison, Guatemala has a rate of more than 50% for at-home treatment, and in Hong Kong, the rate exceeds 80%. In 2019, President Trump signed an executive order setting a goal for 80% of new end-stage renal disease (ESRD) patients to either receive at-home treatment or a kidney transplant. It is unclear whether this goal will be a major priority of his second administration. Additional context More than 800,000 Americans suffer from kidney failure, or ESRD. Roughly two-thirds of ESRD patients rely on dialysis to live, with the other third receiving kidney transplants. Dialysis treatments cost the Medicare and Medicaid programs more than $40 billion per year, according to recent data compiled by the National Institutes of Health. This figure does not include dialysis treatments that are funded through health insurance plans and out-of-pocket payments from patients.
