The Hospice e-News
What the Media Said about End-of-Life Care This Week
Week of September 06, 2006
…a service of
STUDY EXPLORES VALUE OF MEDICAL
SPENDING
A article
published in the current NEJM, “The Value of Medical Spending in the United States,
1960–2000,” reports on a study that compares the “gains in life
expectancy with the increased costs of care from 1960-2000.” Results show that until age 65, life
expectancy rises more sharply than healthcare costs. But after age 65, the cost of medical care
takes a big jump. The study was financed
by federal funds and conducted by researchers at Harvard and the
“From 1960
through 2000,” the article abstract says, “the life expectancy for newborns
increased by 6.97 years, lifetime medical spending adjusted for
inflation increased by approximately $69,000, and the cost per year
of life gained was $19,900. The cost increased from $7,400 per year
of life gained in the 1970s to $36,300 in the 1990s. The average
cost per year of life gained in 1960–2000 was approximately $31,600
at 15 years of age, $53,700 at 45 years of age, and $84,700 at 65
years of age. At 65 years of age, costs rose more rapidly than did
life expectancy: the cost per year of life gained was $121,000
between 1980 and 1990 and $145,000 between 1990 and 2000.”
Other figures, also adjusted for
inflation, show that annual medical spending was about $700 per person in 1960,
compared to more than $6,000 today. At
least half of those costs, however, result from more care being available, not
from higher costs of existing care. Some
of the increases in longevity are attributed to a decline in smoking and in
fatal accidents, but a Washington Post
interview with study author David Cutler says “It is reasonable to attribute at
least half of it to more and better health care.” “On net,” he said, “it's actually been a very
good deal. It's very clear that we don't
need to spend every penny we do spend.
What's also clear is that there's a lot of stuff that is worth it.”
The
Washington Post also spoke with Gerard Anderson, director of the
Center for Hospital Finance and Management at
The
New York Times article cites Dr. Sidney Wolfe, head of health
research at Public Citizen, as agreeing with
The authors conclude by saying, “On
average, the increases in medical spending since 1960 have provided reasonable
value. However, the spending increases
in medical care for the elderly since 1980 are associated with a high cost per
year of life gained. The national focus
on the rise in medical spending should be balanced by attention to the health
benefits of this increased spending.”
Additionally, the authors say, “We
need to continue tracking trends in health care spending and its benefits [with
a] focus on specific diseases in order to provide a more detailed picture of
the value of health care both within disease categories and across a spectrum
of common diseases over time. Also, the
WHO DECIDES ON DIALYSIS WHEN THE
PATIENT CANNOT?
In the 1960’s, a Seattle committee
called the “God squad” determined which patients with end-stage kidney disease
would get to use the dialysis machines, because there were too few machines to
service all the patients. Today, The New York Times says,
that equipment crisis is long over and the current problem is the cost of the
service.
At an annual cost of $16 billion,
more than 300,000 patients a year receive dialysis. Dr. Tony M. Valeri,
director of hemodialysis at Columbia University
Dialysis Center, says, “Dialysis is the default choice” as long as the patient
is stable enough to undergo it. But in
2000, a committee of the Renal Physicians Association and the American Society
of Nephrology developed guidelines for determining when dialysis should be
used. The committee recommended that
dialysis was not appropriate for patients who had “irreversible, profound
neurological impairment” and that “it was reasonable to consider withholding
dialysis from patients with terminal illnesses unrelated to the kidneys.”
The
New York Times cites research published in a recent Neurology article as reporting that, at
Dr. Alvin Moss, who led the
guidelines committee in 2000, refuses to prescribe dialysis when he thinks it
inappropriate. Or, sometimes, the
patient is put on dialysis, but removed if there is no improvement. Moss, who says that he has not yet been sued,
says that he has “thoughtful discussions” with families about what dialysis can
and cannot do.
Other nephrologists think it safer to
provide dialysis to avoid lawsuits, the article says. Some patients have family members who are
unwilling to let their loved one die, Dr. Valeri
says. He’s had family members accuse him
of suggesting euthanasia when he has suggested withholding dialysis. “They think you’re just another Kevorkian,”
he says. (The New York Times, 8/29)
PUBLIC POLICY NOTES
*
* The origins of the money behind a proposed
amendment requiring Nebraska patients to receive food and water, unless they
have clearly expressed otherwise in advance directives, are unclear. But most of the people who were involved in
the effort and were spread across nine states, says an article in the Omaha World-Herald, have connections to
Americans for Limited Government (ALG).
The ALG president, John Tillman, denies that ALG has any position on the
humane care measure. The article says,
“The humane care amendment was created and funded in a way that makes it hard
to sort out its backers.” Deborah
Goldberg, director of the Democracy Project at New York University School of
Law, says that’s a problem. “Don’t you
have a right to know who’s funding policy initiatives
in your state?” she asked. (
* The provision of the recently-passed
immigration bill that makes it easier for foreign nurses to enter the US
“represents a Band-Aid approach to the serious nursing shortage facing this
country and distracts policymakers from addressing the fundamental problems
behind the shortage,” say three Pittsburgh
Post-Gazette writers. “In addition,
recruiting nurses from less affluent nations, which are grappling with their
own shortage of nurses, does great damage to
* In the latter part of 2005, says an
article in The Charlotte Observer, 130
new hospices opened in
* If California Governor Arnold Schwarzenegger
(R) signs a bill paying for hospice care for children, California will be one
of the first states in the country to offer the service. Public funding of hospice for children is
prohibited by federal law, but waivers can be issued, such as the one that
*
OTHER NOTES
* A recent study from the National
League for Nursing reports “a significant drop” in nursing school admissions. An NLN research analyst says, “It might just
be a blip in the data. It could mean
we’re going to start to see a slowdown.”
Another report, by Staffing Industry Analysts, projects “steady revenue
gains for healthcare temporary staffing agencies.” (Modern
Healthcare, 8/28)
* Traditional nursing
home business is staying flat or shrinking, while new areas of nursing home
service, such as short-term care, hospice, home health care and assisted-living
services are growing. Analysts say that
Medicare and Medicaid reimbursement changes “have given nursing home firms a
better sense of where their money’s coming from” and that has “stabilized the
industry and created opportunities for growth.”
(Investor’s Business Daily,
8/28)
* Karl Bernstein is a retired nuclear
engineer who did not make an advance directive or living will. His wife and son are feuding over the kind of
care that Karl, who is an Alzheimer’s and Parkinson’s patient, receives. Bernstein’s wife signed a
DNR order when she placed him in a nursing home, but his son, who is an
attorney, filed for, and won, conservatorship shortly
after. The two have been at odds
ever since. Bernstein has not spoken in
four years and has an artificial feeding tube.
(The
* Dr. Liza Leal, author of Live Well With Chronic Pain, offers pain
sufferers four tips. Make a choice to
live well, learn how to live well by becoming an effective pain manager, make
plans to live well and take action today, not tomorrow. (Market
Wire, 8/29)
* Art Buchwald aside, says an article in The
* A study funded by NIH and the
* A History of Old Age, edited
by Pat Thane, is reviewed in the current JAMA. “The book is beautifully and lavishly
produced, with a plethora of fascinating pictures, photographs, paintings and
cartoons,” the reviewer says. The book
examines ambivalence toward aging and “the effects of local culture and
economics on the lives of elderly people.”
The reviewer notes several faults with the book, including an
“inadequate index” and “no information about the five contributors or their
affiliations.” Still, he says, it
“offers an attractive and interesting introduction to the subject and is worth
the price for the beautiful illustrations alone.” (JAMA,
2006;296:1000-1001)
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* There will be no publication of The Hospice e-News on the week of September 12, 2006. *