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Need links: How nationalized health programs handle end of life costs
Old 05-07-2012, 01:10 AM   #1
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Need links: How nationalized health programs handle end of life costs

Until recently I've paid little attention to health insurance issues except for my own. I'd like some help in catching up.

The issue I'm researching now is how national health plans deal with the huge costs in a persons last six months of life. I have the impression that on average the medical costs for care in a persons last six months is enormous compared to the rest cost of care for the rest of their life, that the cost curve climbs slowly over time then turns and goes almost straight up.

Can you give me links reasonably to even handed articles on any of these 3 issues:
- Cost of care in the last # months of life,
- Do national systems reduce end of life care costs by denying/rationing costly treatment (e.g. rationing by waiting time for treatment, rationing by not providing the more costly treatments, rationing by allowing doctors/hospitals not to participate, simply denying treatments for some conditions)? If so, which countries and do they use other means then the ones I've listed?
- Are there national systems which are financially sustainable but do not deny/ration costly end of life treatment?

I'll take links to discussions but prefer articles because I don't want to wade through forum spew. Don't need info about the US except for cost of care in the last # months of life.

Not looking for a discussion in this thread, unless it's to clarify what info it is I'm asking for.

Thanks.
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ItDontMeanAThing is offline   Reply With Quote
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Old 05-07-2012, 03:12 AM   #2
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Quote:
Originally Posted by ItDontMeanAThing View Post
The issue I'm researching now is how national health plans deal with the huge costs in a persons last six months of life. I have the impression that on average the medical costs for care in a persons last six months is enormous compared to the rest cost of care for the rest of their life, that the cost curve climbs slowly over time then turns and goes almost straight up.
I think you might want to check that impression first. I'm guessing that health care costs actually increase steadily over the last 15-20 years of life. That could of course itself be a per-system thing (for example, one can imagine systems which are better or worse at getting people to take their meds), but either way I suspect that it could undermine your basic idea, which (if I've interpreted it correctly) seems to be that health care systems are faced with massive increases in the last six months, and so have to face up to various ethical and financial dilemmas.

As for the rest of your request: GIYF. Apart from anything else, your questions are phrased in semi-emotive terms: I can imagine a research paper answering the second part of "Are there national systems which are financially sustainable but do not deny/ration costly end of life treatment?", but eliminating those systems which are "not financially sustainable" from the equation would seem to be a fairly political point of view. FWIW, France doesn't seem to take cost into account as much as the UK.
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Old 05-07-2012, 10:35 AM   #3
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https://secure.cihi.ca/free_products...rt_aug07_e.pdf

Here is a link to a study on end of life care in western Canada from 2007. I don't believe it has been repeated.
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