As I look for a position in the non-profit world helping with Health Care, I continue to learn through my informal study of health care expenses and wonder how I can contribute to helping find a path to affordable health care for all.
There is no lack of focus on this issue down in the trenches of the existing heath care system I have come to learn and I recommend reading this book to see how end of life care can be both humane, extend life a little or lot through modern medical knowledge and have its costs better controlled.
The book is recommending exactly what did not happen in the case of mother which resulted in $400,000 of wasted expenditures on end of life care and illustrates a process by which it would have been decided that my mother should have had her DNR request honored while someone else could have recovered and lived a longer useful life. No death panels are required at any level, only families and doctors making caring decisions about issues that cannot be avoided.
The book shows that not all expensive end of life treatments are wasted funds. There can be successful treatments that allow people to live productive lives for a reasonable period of time. There are also less expensive treatments that improve the quality of life for people who are on some path toward near term death.
The key thing the book advocates is breaking free from notion that everyone who is acutely ill needs to be treated for a comprehensive manner so the current point of care can "cure" the individual of everything. That is what the acute care system is designed to do and it works for people in car accidents and other things that happen to younger people. It even works for the elderly in the right circumstances. What it does not work for is when a person is dying and the only reasonable thing to do is make the person comfortable. That is when an incredible amount of money is wasted.
To get there, hospitals need to look at the best practices on cost controls that are out there. Some hospitals are well along in learning how Palliative Care works while others have not even started. For example, the book cites a Dartmouth Atlas of Health Care study that found UVLA spends an average of $93,482 for the last 2 years of an individual's life while the Mayo Clinic spends $53,432 for the equivalent population. Does anyone think the Mayo Clinic provides inadequate care?
Hospice care is an important part of the cost control solution but Medicare policies need to be changed to allow more flexibility in the use of hospice care.
The one thing the book emphasizes over and over again is people will make the best decisions for themselves if they are given full information, their feelings are well understood, and they are allowed to be cared for at home, if possible. Most people want to die at home. Most people die in the hospital or a nursing home. Why? Because 50% of men and 75% of women over age 75 are living alone and have no care giver to go home to and the system is not set up to pay for reduced cost maintenance care.
This book was an eye opener for me and is written in a manner that easily kept me wanting to read more. I recommend it highly.
No comments:
Post a Comment