Dialyzer reuse: an evolving search for efficiency.
The evolution of dialyzer reuse in the United States provides an opportunity to examine the dialysis community's response to changing financial conditions and incentives. As background, we provide a conceptual framework to explain the factors governing the diffusion of dialysis technologies and then describe the clinical context in which reuse programs have developed. Early in its evolution, dialyzer reuse arose principally from the desire to reduce costs under a system of capitated payments. More recently, despite evidence of an adverse health effect, cost-savings from reuse have permitted the adoption of new and expensive technologies. The net effect of the tradeoff's between cost and quality should, ideally, drive the decision to reuse dialyzers. However, even if such tradeoffs can be fully characterized, incentives to implement efficiencies created by capitated systems of payment will continue to influence practice.