Survival for $25,000

At 29, Don Shevlin was just two months away from taking his oral exams for a Ph.D. in English at U.C.L.A. Today, two years later, he has neither the degree nor any prospect of a teaching job. Says he: "I see myself as perennially pauperized."

Shevlin suffers from chronic kidney disease, an incurable type that necessitated the removal of the organ. Now, in order to prevent a fatal buildup of toxins in his blood, he must report to the university hospital three times a week for kidney dialysis, a six-hour cleansing process that enables him to survive until he can get a kidney transplant. Since his illness wiped out his small savings, Shevlin lives on welfare payments of $178 a month, while the State of California pays for most of the cost of his treatments --which amounts to $3,000 a month.

Shevlin's position is not unique. Nearly 5,000 Americans are currently undergoing regular kidney dialysis. Thousands more would choose such treatment if it were more widely available, but none can escape the gigantic cost of staying alive.

Ruinous Rates. The annual hospital charge for in-patient dialysis averages about $25,000. New York Hospital's newly opened Rogosin Kidney Disease Treatment Center, which operates 14 units (and treated former U.N. Under Secretary-General Ralph Bunche until his death last week), charges $200 per treatment; hospitals in the Boston area charge anywhere from $148 to $337 but bill separately for doctors' services.

The hospitals' own expenses are high. Dialysis machines cost from $2,600 to $5,000; disposable filters and tubing, which are generally used only once, run as high as $14 to $28 per treatment. Almost no patients can afford to pay the full price, but most hospitals will not turn a patient away for lack of funds. Hospitals usually charge patients who have insurance only what their policies allow, then write off the remainder. But many insurance policies fail to provide adequate funds for long-term dialysis. Among uninsured patients, many turn to the state to finance their treatments.

Over the Limit. The terms for state aid often are stern. California's Medical program limits its assistance to families living at federally established poverty levels. Thus Maurice Chriqui, an employee of a Los Angeles architectural firm, applied for help to pay for his wife's dialysis and learned that he was ineligible if he had more than $1,200 in his bank account. Chriqui was $60 over the limit, so he ran out and spent the money in order to qualify. Others have been forced to sell their homes or cars before becoming eligible for assistance.

Most doctors and hospital officials see little chance of reducing the costs for in-hospital dialysis. But medical men are looking for less expensive alternatives to the present system. Many have found that dialysis can be performed more cheaply on an out-patient basis and are trying to persuade insurance companies, many of which now pay only for in-hospital treatment, to finance this approach.

Others see the answer in private dialysis centers, which have no hospital overhead and therefore can make a profit while providing the service at lower rates. Boston's Babcock Artificial Kidney Center charges an all-inclusive $160 per treatment and plans to lower its price to $130--as compared to $387 at the nearby Peter Bent Brigham Hospital.

Transplant Bargain. Some doctors see home dialysis as a solution. This costs $15,000 in the first year, when equipment must be purchased, but drops to about $5,000 a year thereafter. Home dialysis requires training in the use of the machine, however, and adjustment to the long hours of self-treatment. "This machine ruins your ego completely," says Dr. Eugene Hoffman Sr., senior medical adviser to Blue Cross of Southern California. "People who use it have nothing else to hang on to."

But most doctors--and patients as well--agree that the best way to avoid the high costs of chronic dialysis is to make it unnecessary. About 90% of the patients currently undergoing dialysis are suitable candidates for kidney transplants. The success rate for transplantation of kidneys from live donors is around 70%, while that for operations using cadaver kidneys is almost 50%. The cost of a new kidney is a bargain of sorts: a maximum of $25,000, or about one year's worth of in-hospital dialysis. Unfortunately, the supply of donor kidneys is far smaller than the demand, and many patients must wait months and sometimes years. Until this shortage is met, patients with kidney disease will continue to go into dialysis--and debt--just to stay alive.

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