Even though end of life care is an important healthcare policy, it can be regarded as non-feasible, thus making several patients to die at home with the support of hospice and family, instead of spending a lot of money on ICU hospital bills and patient visits. End of life care systems are put in place so that they can meet and satisfy the healthcare needs of people. They have the mandate to deliver healthcare services to the intended group or population and ensure fair contribution of finances. The set up of these systems vary from one country/state to another, though they seem to have similar goals since they are geared towards promoting and maintaining the best quality end of life care service delivery to the citizens. The systems play a major role and should be maintained and supported if people are to achieve the desired standards, regarding the end of life care services delivery. This include proper design and plan of the structures, which constitute the participation of the government, charities, trade unions, employers, religious groups, and all coordinated bodies to deliver the intended end of life care services to the intended populations (Ventres, 2011).
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Overview of the healthcare issue
Currently, several countries across the world have problems with their end of life care systems and the United States is not an exception, as there areseveral issues affecting the end of life care in the US system (Ventres, 2011). This has never changed since then, and the situation is becoming worse, since many Americans are not getting the health insurance cover. These problems emanate from the stakeholders in the end of life care system. The current system is purely government, which is not acceptable. The public sector should be in partnership with the private sector to encourage healthy competition for the end of life care service delivery. If citizens are given a choice of both public and private mix, then it is obvious that this will be a preference to pure government system.
There are restrictions where people have to take up insurance covers based on their employers’ demand and not their own choice of health insurance cover. The implication is that people end up being locked in their jobs for fear of losing their health cover. Currently, patients undergo a lot of problems when trying to access the doctors, and this is another major challenge in the end of life care system. Moreover, the physicians often have problems in accessing the patients’ records. Lack of consistency in measuring the quality of end of life care and using the findings in decision making is another problem (Gapenski, 2009).
The most significant problem in the end of life care system today in the United States is majorly the finance. End of life care has become very expensive and the prices are skyrocketing every day. It is true that guaranteeing fundamental end of life care for everyone will be expensive. According to Gapenski, “covering the uninsured would cost an estimated $88.6 billion in today’s dollars” (Gapenski, 2009). The current situation of end of life care system indicates that there are many problems that need to be fixed. Other highlighted issues can be handled by change of policies. For the future generation, there is a need to ensure universal coverage for all. This will ensure every American citizen is registered in an essential health plan of their choice. The government also needs to change its policies and integrate the private sector, so that they can work hand in hand in ensuring better end of life care production. In this regard, Gerald Neuberg re-affirmed that:
“After 2 years, the groups saved Medicare an estimated $34 million on care of beneficiaries with diabetes, coronary disease, and CHF while maintaining excellent scores on quality measures such as diabetes control. The payment formulas need revision since, for most groups, administrative costs exceeded their bonus payments, but the concept that cohort-based, risk-adjusted cost measures and incentives can deter unnecessary care appears valid” (Neuberg, 2008).
End of Life Care and Death in America Cost Analysis
It is true to say that the United States system of end of life care is quite unique. In fact, the system is characterized by presence of subsystems, imbalanced access to end of life care services as a result of lacking insurance cover for all, existence many players and absence of central bureau to preside over the system and many other features that affect end of life care delivery in the country (Gapenski, 2009). To this end, cost is a wide topic of discussion and the main focus is in ways of reducing the skyrocketing costs, since it is obvious that the cost of end of life care in the United States has shot and is continuing to rise with time. It is said that in the year 2010, the expenditure of health neared $ 2.6 trillion in the United States alone (U.S Healthcare Costs, 2012). This figure is more than ten times that spent in 1980. This is still expected to grow faster than the national income over the foreseeable future (Raymond, Jonas & Karen, 2007). This can be supported by the following assertion:
“This elegant study demonstrated that in the aggregate, the highest levels of spending include substantial amounts of wasteful and possibly harmful overtreatment. However, the association of high end-of-life spending with overtreatment among large cohorts of comparable illness severity does not prove that end-of-life spending itself is independent of illness severity, as is assumed in the Atlas” (Neuberg, 2008).
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It is true that “the notion of cost-effectiveness is used in other countries, but the Americans have been unwilling to accept the denial of medical care on that premise” (Raymond, Jonas & Karen, 2007). In fact; experts believe that much of the end of life care services being offered in the United States are a tax burden on the states’ budget expenditure (Rettig, 2012). Everybody can agree that health issues are sensitive, and all the necessary measures have to be put in place to ensure quality. However, the misconception that in an attempt to be cost-effective would result to quality undermine is misleading and these are some of the reasons why the cost of end of life care in the United States of America has always been on the rise. This can be associated with unnecessary pride where the rich and the most influential people, such the political elites and the most successful business people fight to keep the access to health services unreasonably high in the name of quality when the poor are languishing without coverage of health insurance and generally access to proper medicare facilities. It is an irony that as the world struggles to attain cost effectiveness in its service delivery to the citizens; this does not apply to the health sector, and especially in the United States (Buntin, Haviland & Sood, 2011).
The very first step is to embrace the fact that the citizens can still achieve better health services at a cheaper cost, thereby getting the most cost effective services. According to Madeline, most medical treatments lack evidence that they are effective (Madeline, 2010). For example, USD1.1 billion set for medical intervention research in the United States is not a financially feasible venture (Madeline, 2010). This implies that the cost has been on the rise yet most of the treatment is actually non effective at all. Therefore, confirming the previous belief that high cost does not necessarily mean better and quality delivery of end of life care. Madeline further gives a case study of Texas City and El-Paso which is 800 miles away (Madeline, 2010). In McAllen, Texas Medicare expenditure hovered around $15000 per person enrolled while in El-Paso, the amount was half as much (U.S Healthcare Costs, 2012). The major concern is that the two cities are only 800 miles away from each other and thereby the discrepancy is not explained by the figures. “Compared to patients in El Paso and nationwide, patients in McAllen got more of pretty much everything – more diagnostic testing, more hospital treatment, more surgery, more home care” (Atul, 2009). This observation clearly indicates that a better end of life care system is what delivers quality services and at a cheaper cost as compared to incurring much resource expenditure with little benefits if any. “Many studies have demonstrated that NPPs can provide both high-quality and cost-effective medical care, because they show greater personal interest in patients” (Leiyu & Singh, 2009).
Atul concludes that the discontent of many physicians is attributable to frustrations in their attempts to deliver ideal end of life care, restrictions on their personal time, financial incentives that strain their professional principles, and loss of control over their clinical decisions (Atul, 2009). Moreover, various studies reveal that in the cost of end of life care in the US is generally high, but without some valid reasons, and these are some of the challenges that need to be looked into. There is a need to carry out some thorough investigations so that the root causes of the end of life care problems in the United States can be found out. It is from the investigated findings that some tangible solutions can be reached. Importantly, there is some glimmer of hope, if all the stakeholders and policy makers in the US end of life care system agree to hold meetings to reach at some amicable solutions. Therefore, some level of change can be achieved. This change can be achieved if all the involved stakeholders in the end of life care sector collaborate and work together (Retting, 2012). Looking at employers, they can play a big role in working towards a better end of life care provision. Every employer should be focusing on ways of improving the standards of health status of their employees and at the same time promoting the quality and cost of end of life care provision. In efforts to save the common people from the high and rising costs of end of life care, President Barrack Obama and the Congress has paid more concentration to the cost involved.
Access has become difficult due to the policies which could be changed to accommodate self choice of insurance covers as opposed to employees having to force their staff into adopting the set policies strictly. The government, on the other hand, can work with the private sector and together offer the citizens of the United States a better end of life care system; a system where there is stiff competition which results into the reduced costs and better end of life care services. At the same time, the government should embrace the cover for all policy where the government ensures that everyone in the country is ensured. The fact that about 45 million Americans are uninsured is shocking and these results into patient’s having to hassle as a result of high rise of premiums (U.S Healthcare, 2012). It is time American citizens embraced the concept of cost-effectiveness by looking at drugs and technologies from the economic point of view and do comparison to available alternatives. The major concerns should not only be what cost will be incurred, but also the worth of the cost. With this in mind, then we can say that it is not necessarily that expensive treatments are always of bad value, since some costly breakthroughs bring about better outcomes, and for this reason worth the investment. Moreover, it has been found that in some cases, very expensive tests and surgeries are carried out and at the end of the day, they are found to have been unnecessary, these means that cost has been incurred without returns. This is not just in complex cases involving tests and surgeries, but also in general medical treatment.
It can also be argued that due to high costs of medical intervention, several patients end up intoxicated and become worse instead of improving as expected. Moreover, cost of end of life care situation at home is not always cheaper since “if you need someone to come in, you know, once or twice a day, can be very expensive. It can cost, you know, tens of thousands of dollars a year. Aging is not for the faint of heart or the small of pocketbook” (At End of Life… Soaring Prices, Sinking Resources, 2011)
A study from the Dartmouth Medical School, which suggests that often patients in highly-cost areas get much more expensive treatment of the marginal value, but less quality. According to Madeline, “they get more of the expensive, but not more of help they needed” (Madeline, 2010). The observations pose questions to as whether expensive equals quality. Its high time health matters get serious attention instead of imitating the famous Veblen goods, such as cars and jewelry whose preference increases with increase of their price citing superior status. This is health, and it cannot be compared to any other good in the market, so people ought to know that the cheaper end of life care services become, the better it is for all citizens and this could even give more room for scientists to carry out more research and come up with effective vaccines, hence reducing investments in curative medicine. Other cases relating to finances include an imperfect market situation, presence of third party insurers who come in as intermediaries linking the aspects of financing and delivery of end of life care, new and costly medical technology and emphasis on quality enhancement. It has been discovered that the more we get intermediaries in the business, the more expensive the services and goods are to the consumer. However, a policy would be adopted connecting the end of life care providers and people in need of these services directly instead of having to go through a pool of intermediates ending up with unbearable rates to bear (Retting, 2012).
It is still possible to tame the rising costs of end of life care and provide the Americans with the best services, at good rates. It all starts from individuals having the will. The end of life care system is currently broken, but all has not been lost. Everybody wants a relaxed working environment and this extends to those staff in the end of life care department as well. They should be given adequate incentives and a better working environment in order to deliver the best to the patients in general. It is obvious that it is important to ensure everyone has access to affordable end of life care. It is sad that even those who have health insurance are increasingly facing affordability problems in terms of paying for their end of life care. This is because analysis identifies families and individuals as underinsured, if they are forced to spend at least ten percent of their income on end of life care from their pockets. As citizens look forward to having a better system, there is some hope that all the stakeholders concerned will work together towards achieving better terms.
At End of Life… Soaring Prices, Sinking Resources. (2011). Web.
Atul, G. (2009). The New Yorker. New York, NY: Irvine Publishers.
Buntin, M., Haviland, A.,& Sood, N.(2011). Healthcare Spending and Preventive Care in High-Deductible and Consumer-Directed Health Plans. Washington, DC: VA Publishers.
Gapenski. L. (2009). Fundamentals of Healthcare Finance. New York, AUPHA Press.
Leiyu, S., Singh, D. (2009). Essentials of the United States Health Care System. Oxford: Oxford University Publications.
Madeline, D. (2010). Can cost-Effective Health care= Better Healthcare? Boston, Harvard Publication.
Neuberg, G. (2008). The Cost of End-of-Life Care A New Efficiency Measure Falls Short of AHA/ACC Standards. New York, NY: Broadway Publishers.
Raymond, G., Jonas, S. & and Karen, G. (2007). An Introduction to the US healthcare System. Oxford: Oxford University Publications.
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Rettig, R. (2012). Medical Innovation Duels Cost Containment. New York, NY: PubMed Publishers.
U.S Healthcare Costs. (2012). Web.
Ventres, W. (2011). Answers to US Health Care Issues from other Countries. Oxford: FamMed Publishers.