Care for immigrants with end-stage renal disease in Houston: a comparison of two practices

In 1997, the practice for treating undocumented immigrant patients with end-stage renal disease (ESRD) at a Houston public hospital changed. In this study, we compare the two systems that evolved. Newly encountered immigrants with ESRD were provided only emergent dialysis, while patients previously on scheduled dialysis were "grandfathered in" and maintained on care equivalent to that provided to US citizens. Primary measures compared were patient utilization of hospital services, self-perceived satisfaction, and costs. Thirteen newly diagnosed emergent care patients were compared with 22 patients with unchanged levels of care. For the emergent group, patient utilization of beds and emergency room facilities was higher, patient satisfaction was lower for all but one index, and total costs of care were more than 3.7 times higher. Restricting care for undocumented immigrants with ESRD in our system resulted in greater utilization of hospital services, lower patient satisfaction, and increased cost.