Friday, September 11, 2009

Medicare End of Life Care Part 2

I want to continue to talk about the issue of end of life care and Medicare, and point out some of the problems we are going to have to come to terms with without the rhetoric of "death panels'" and "We are not going to pull the plug on Grandma".

I am using the definition of end of life care to include all the medical services and costs associated with treatments provided in the last year of a person's life. Since the majority of deaths are in patients 65 and older Medicare is the primary payor for these services and it is important to know what I pointed out yesterday in that Medicare is going broke and it is projected that within eight years all assets will be completely depleted. This is a dire circumstance and one that is being avoided by both political parties in all the discussions about health care reform.

So how does this relate to end of life care? 80% of people who die here in the United States are Medicare beneficiaries. 27% of Medicare's total budget is spent on last year of life care with 40% of that in the last 30 days of life. Any reductions in Medicare costs is going to have to take into account end of life care with the goal of having more people who die of chronic terminal illnesses die at home or in hospice care rather than in hospitals. Hospital care results in greater costs not just for the hospitalization itself but all the expensive tests including MRIs and laboratory work. Many of these costs are for treatments that may extend the life span of someone with a chronic terminal illness by one or two days. That will have to change. Unfortunately, most people don't have access to hospice care and ethnic minorities have even less access that whites.

I am not saying that limiting end of life care is a good thing. But it will have to be done and this is an area that is being avoided in all the various discussions about health care reform.

Thought for the day

One of the problems of deliberate rationed care is that someone has to do the rationing.

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