with the enactment of section 2991 of the social security amendments of 1972 ( public law 92 - 603 ) , full medicare coverage was extended to persons with end stage renal disease ( esrd ) , effective july 1 , 1973 . to be eligible for medicare esrd benefits ,
the patient must first be currently or fully insured , be eligible for social security benefits , or be the spouse or a dependent child of such a person .
additionally , a physician must certify that the individual requires chronic dialysis or a kidney transplant to maintain life .
the medicare program pays a prospectively determined amount for kidney transplants and for certain drug treatments . for example , immunosuppressive drugs prescribed for transplant recipients are covered by medicare for 1 year following discharge from the transplant hospitalization . the drug , epoietin , used to combat anemia in dialysis patients , was added to medicare coverage effective june 1 , 1989 .
integral to the effective management of the esrd program is the operation of a comprehensive data base covering medical and demographic information for the medicare esrd population .
this data base , along with other esrd program - related data , is a part of a larger computer system  the esrd program management and medical information system .
this system served as the principal source for the data used in this article . in this article , trends for the medicare esrd population are examined by comparing : esrd enrollment with the total medicare enrollment ( i.e. , the count of people enrolled for coverage at a certain point in time ) .
rates of growth for enrollment in esrd by age groups and for the incidence ( new cases ) of esrd by age groups .
( these comparisons are made to provide evidence of the aging of the esrd population . )
the comparison of esrd to the total medicare program in terms of numbers of beneficiaries enrolled and expenditures is shown in table 1 .
this table shows that the esrd population is growing at a much faster rate than the medicare population in general .
esrd enrollment increased from 76,412 in 1982 to 124,197 in 1987 , an average annual increase of 10.2 percent .
for the same period , total medicare enrollment increased from 29,494,219 to 32,411,204 , an average annual increase of only 1.9 percent . from 1985 through 1987 ,
however , the annual growth rates for the esrd beneficiaries consistently decreased from 13.1 percent in 1983 to 8.7 percent in 1987 .
( a summary of these rates of increase , by year , is shown in table 4 . ) in figure 1 , the annual rates of growth of the total medicare population and the esrd population for the years 1983 through 1987 reflect the decreasing differential in annual rate of growth .
even though the annual rate of growth for esrd enrollment decreased during this period , esrd beneficiaries continued to increase as a percent of the total medicare population . in table 1 , it can be seen that , in 1982 , esrd represented 0.26 percent of the overall medicare population . by 1987
expenditures for the esrd population are disproportionately high when compared with the relationship between the total number of esrd beneficiaries and the total number of medicare beneficiaries ( table 1 ) . in 1984 , $ 2,332.6 million , or 4 percent , of the $ 58,354.2 million total expenditures for medicare were used for esrd beneficiaries . in this same year , the 95,526 esrd beneficiaries represented only 0.31 percent of the total of 30,455,971 medicare beneficiaries .
this proportion peaked in 1986 when the esrd expenditures of $ 3,047.6 million represented 4.44 percent of the $ 68,582.5 million total medicare expenditures .
however , the 114,306 esrd enrollees were only 0.36 percent of the total of 31,749,708 medicare beneficiaries . by 1987 ,
the esrd expenditures of $ 3,315.4 were 4.39 percent of the $ 75,442.1 million total medicare expenditures , while 124,197 esrd enrollees represented only 0.38 percent of the total of 32,411,204 medicare beneficiaries .
the average annual rate of increase for expenditures for the esrd population , from 1983 to 1987 , was better than 3 percentage points higher than that for medicare in general ( 12.4 percent and 8.9 percent , respectively ) .
the enrollment data discussed in this section reflect counts of all beneficiaries who were enrolled for coverage under the esrd program on december 31 of each year .
table 2 contains data on esrd beneficiaries by whether they were on dialysis treatment or whether they had a functioning transplanted kidney and by age . in 1982 , there were 76,412 esrd beneficiaries enrolled in the medicare program . by 1987 , this number had increased to 124,197 , a 63-percent increase . however , the growth rate for enrollment , which was 13.1 percent between 1982 and 1983 , had decreased to 8.7 percent between 1986 and 1987 ( table 4 ) . from 1982 to 1983 , the total number of esrd dialysis patients increased from 65,597 to 73,438 , an annual rate of increase of 11.9 percent . however , for those 65 years of age or over , the rate of increase was 1.9 times larger at 22.3 percent ( 18,155 in 1982 to 22,201 in 1983 ) . from 1986
( 90,841 enrollees ) to 1987 ( 97,111 enrollees ) , the annual rate of increase for all dialysis patients had declined to 6.9 percent . for those 65 years of age or over ( 31,558 in 1986 and 34,911 in 1987 ) , the rate also declined , but at 10.6 percent , it was still 1.5 times larger than the overall rate .
the average annual rate of increase from 1982 to 1987 was 8.2 percent for all dialysis patients , but it was 14.0 percent for those 65 years of age or over ( table 4 ) . in figure 2 , the rates of increase in enrollment for all dialysis patients are compared to the rates of increase in enrollment for those 65 years of age during the period from 1982 - 87 .
the average annual rate of increase for this same period , 1982 to 1987 , for functioning kidney transplants was 20.2 percent .
the rate for transplants for those 65 years of age or over was more than double that rate at 45.0 percent ( table 4 ) .
the number of enrollees in table 2 shows that , in terms of the total dialysis beneficiaries , the group 65 years of age or over increased from 18,155 in 1982 ( 27.7 percent of the 65,597 total esrd dialysis population ) to 34,911 in 1987 ( 35.9 percent of the 97,111 total ) .
the number of beneficiaries with functioning kidney transplants who were 65 years of age or over increased from 114 ( 1.1 percent of the 10,815 total esrd transplant population ) in 1982 , to 731 ( 2.7 percent of the 27,086 total ) in 1987 .
the total counts of esrd incidence ( newly enrolled medicare esrd beneficiaries ) by age are shown in table 3 .
the trend in medicare esrd incidence supports that which was found in esrd enrollment ; that is , the esrd population is aging . in 1982
, 21,876 persons were added to the medicare enrollment files as esrd beneficiaries . by 1987 ,
the annual number of new esrd beneficiaries had increased to 33,749 , representing an average annual rate of increase over the 6-year period of 9.1 percent .
however , there were 6,424 beneficiaries 65 years of age or over added in 1982 and 12,844 added in 1987 , which represented an average annual rate of increase of 14.9 percent .
( a summary of the rates of increase in incidence of esrd , along with those of enrollment , are included in table 4 , for comparison . ) from 1986 to 1987 , the number of newly enrolled esrd beneficiaries increased by only 7.7 percent , from 31,328 in 1986 to 33,749 in 1987 .
this annual rate of increase indicates a slowing of overall growth in new cases of esrd , when compared with the average annual rate of increase of 9.1 percent from 1982 to 1987 .
the annual rate of growth for new cases of esrd among older persons has also slowed , but for the last 3 years shown , it has consistently exceeded the average annual rate of growth of esrd overall . from 1984 to 1985 ,
the annual rate of growth in incidence for all ages was 10.7 percent ( 26,453 to 29,290 , respectively ) ; for those 65 years of age or over , it was 15.4 percent ( 9,100 to 10,498 , respectively ) . from 1985 to 1986 ,
the annual rate of growth in incidence was 7.0 percent ( 29,290 to 31,328 , respectively ) ; for those 65 years of age or over it was 11.0 percent ( 10,498 to 11,648 , respectively ) . from 1986 to 1987 , the annual rate of growth in incidence was 7.7 percent 31,328 to 33,749 , respectively ) ; for those 65 years of age or over , it was 10.3 percent ( 11,648 to 12,844 , respectively ) . a final indicator of the aging of the esrd population is also found in incidence rates . in 1982 ,
there were 6,424 esrd beneficiaries in the group 65 years of age or over , which represented 29.4 percent of the total incidence of 21,876 for that year . by 1987 ,
the 12,844 new esrd cases in the 65 years of age or over group represented 38.1 percent of the total incidence .
it has been shown that the esrd population is growing at a much faster rate than the general medicare population . also , it has been shown that the esrd beneficiaries consistently use a disproportionately higher share of medicare funds compared with their representation in the total medicare population .
the esrd statistics also reflect a clear trend in the aging of the esrd population . the reasons for why this may be happening
were not examined , but it has been clearly shown that the group 65 years of age or over continues to represent a larger portion of esrd enrollment and of esrd incidence , over time .
 a synopsis is given between the relationship of the number of end stage renal disease ( esrd ) patients to the total medicare population and their associated expenditures . 
 the aging trend within the esrd population is examined in terms of enrollment statistics and incidence ( new cases ) counts . 
 also , longitudinal trends in expenditures , program enrollment , and incidence of esrd are included . 
 findings indicate that the esrd population is growing at a faster rate than medicare in general . 
 further , within esrd , the beneficiary population is aging . 
Background
Population growth rates
Aging population enrollment
Aging population in incidence
Conclusion