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Tuesday, January 26, 2010

Why is always in the last place you look: medical expenditures at the end of life

Now this is a rather obvious point to make, but it still bears making. I keep hearing people  shaking their heads over the fact that costs for medical care in the last year of life far outstrip the costs before that time.  In an article published in Health Services Research, based on costs of care over 10 years ago, showed an average yearly cost for Medicare recipients of a bit over $7000, but a cost of over $37,000 for the last year of life.
Now if I knew I was going to die, I certainly wouldn’t want to spend $37,000 receiving boring and unpleasant medical care. But if I knew that the Apple company was going to do so well, I would have bought low.
Of course medical costs are high in the final year of life, because that is the year of life when most people are sickest, and therefore are getting the most amount of medical care. Certainly having discussions with patients about what they want when they get close to the end of their lives will save money.  This will reduce the horrendous “flail fests” when a person clearly approaching death with no reasonable chance of survival is subjected to ridiculously intensive life support.  This can even reduce everyday wasteful medical expenditures, such as expensive consultations, feeding tubes and the like in the cases of people who are clearly dying of the diseases of old age that take away quality of life and are not reversible.
Having “end of life” discussions will help in all sorts of ways to focus effort on improving the quality of life and the quality of death for people who are exiting the world. They will also save money that can be diverted to providing basic and vitally important health care to people who really need it.
All this said, in the best of all possible worlds, we still want medical expenditures at the end of life to outstrip medical expenditures before that time, because we do want to make sure that care is given in the most appropriate way possible when people are very sick.  In the best of all possible worlds, though, that disparity will be significantly smaller than it is now.

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