There are three times as many blacks on dialysis per million persons as whites in the United States population. The authors argued that, in order to measure whether discrimination in the allocation of dialysis treatment exists, it is necessary to demonstrate the rate of patients treated on dialysis among those could benefit from treatment. The present study “introduced two new concepts for the measure of distributive justice in medicine: percentage or fraction dialyzed (the number of patients treated divided by the number of patients in need of treatment) and the discrimination index (the fraction dialyzed in all groups divided by the fraction dialyzed in the group of interest).”

The data for this study were derived from Health Care Finance Administration data (the number of patients treated) for 1979 and from Vital Statistics of the United States for 1979 (death certificates).

With regard to race, the above indices show evidence of reverse discrimination – there is a 30% increased chance of being dialyzed for blacks. Age-stratification was performed because 90% of the differences between blacks and whites in the fraction treated was explained by age grouping. In this analysis, for both men and women, whites had a higher fraction dialyzed for all but the oldest (65 years plus) age group. The discrimination index for blacks in the younger age groups ranged from 1.07 to 1.27; for whites in the oldest age group, it ranged from 1.67 to 1.99.

The authors state that “there is discrimination against women and blacks, but most of all against the old.” They argue that “medicine now has to contend with two new social forces. One is a decrease in support of the care of the old, the sick and the poor. The second is the commercialization of medicine.”

The authors conclude that the fraction treated and the discrimination index are the best measures available and suggested that they can be further improved by incorporating correction factors based on findings of the absolute contraindications to dialysis.