Bloody Shame

Unnecessary regulations are making blood banks run dry.

Caroline Waters from the July 2004 issue

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"Where do we cut our expenses?" Katz asks. "In infrastructure, personnel, or investment in donor recruitment?" He says that when Medicare ignores the increased costs of new safety initiatives and doesn't adjust reimbursement to the end users (hospitals), the blood banks are under tremendous pressure to hold the line on their prices. And since most insurance companies use the reimbursement level set by the Centers for Medicine and Medicaid Service (CMS) as a benchmark, its policy "ripples throughout the entire health care system."

If CMS tied its reimbursement schedule to the increased costs of blood safety, Katz says, blood banks could use the extra funds to invest in donor recruitment. "We don't need 'help,'" he says. "We need for the unfunded mandates of the FDA to be funded by CMS. That would not be 'help'; it would be rational."

Another logical step would be to offer blood donors a cash incentive -- a proposal that's been met with fierce opposition in the past from those who believe paying for blood would attract people who are so desperate for money that they might not be honest in responding to the screening questionnaire. (Plasma donors, interestingly, have been financially compensated for years.) But according to Richard Epstein, a legal scholar at the University of Chicago and author of Mortal Peril: Our Inalienable Right To Health Care? (2000), quality can be controlled by direct inspection in virtually all cases. (He does agree that some populations should be excluded, such as AIDS patients, intravenous drug users, and alcoholics.)

And the truth is that blood banks already offer donor incentives. Blood Centers of the Pacific gives its donors T-shirts and raffles prizes, for instance, along with the standard post-donation juice and cookies. It's hard to understand why the difference between cash and prizes should stand in the way of a potentially ample blood
supply.