Spending controls on dialysis has created all sorts of weirdness. I learned a lot researching a non-sterile dialysis method about 17 years ago (it worked in animals, but we couldn’t figure out how to make any money, much less pay for the clinical trials. Ask for details if you are curious).
At the time, payments for dialysis had been capped and unchanged for 20 years. Inflation and costs increased, but income per patient didn’t. The dialysis clinics had to become extremely efficient. They eventually turned into these mass production clinics with one nephrologist on staff serving hundreds of patients. The places made good money because of economies of scale at every level. But they had to stay ruthlessly efficient in order keep the doors open. People running them did not always have the best reputation.
Maybe caps were increased some times since then. But it was caps that created the industry we see today.
