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Archive for the ‘Health Care Industry’ Category

In a meeting last week a colleague handed me an article written by a women who was shocked to discover the cost of care for her husband in his final weeks of life.  Her husband died of a cancer that was not curable.  From the article it appears that he had the best of care with nothing held back.  In hindsight the wife muses that wouldn’t it have been nice to spend that money to feed thousands of starving children.

The colleague gave me the article because I am in hospice and she felt that I would agree.  It was a compelling story and I pondered the author’s opinions for days.  I gathered my thoughts and observations and am sharing them with you today.

As Americans, we can be fiercely independent.  We want and demand the best in care.  We want it now, we expect it to be safe, and we believe in our chances for success.  Physicians are also Americans and they want the same things for themselves and their patients.  We are strong we are invincible and we succeed.

We also feel free to sue if things do not go as we expect.  Our television air waves are filled with lawyers suggesting that you sue for experimental treatments gone wrong, any kind of wound, or any imagined wrong.  It seems to be the American way.

We are a death denying society.  We willing admit that live is short, live it to the fullest, but we do not really think that death applies to us, at least not until we are over 90.

I do believe that end of life care is often provided in ICUs or expensive hospital beds when the location and level of care is futile, though I know first hand how difficult it is to tell families that it is time to seek hospice.  Not to do another scan.  Not to try another treatment.  People fly loved ones all over the country and world for experimental treatments on hope alone most times, even when they have experts in their own home town.

Is it possible to tell a patient and family no to another possible treatment when there is a 2% chance that it might work?  What if the chance is 5% or 10%?  We all hear about those miracle cases.  When is enough, enough?  We spend allot on care at the end-of-life because we have the tools.  Man will use the tools Man has.  Is it right?

I believe that we need to be honest with patients and families about the disease process and our current tools to deal with their disease.  We must, as providers, admit to what we can do and what we can not do.  We are not yet able to prevent death.  At some point all body systems will fail and we will not be able to forestall the inevitable.  I also believe that we need to use our expertise, experience, and wisdom to help our patients have the best death possible.  We help mothers and fathers bring babies into this world and we need to help patients and families leave this world with the same dignity and celebration of life.

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The health care of the present is not your grandmother’s health care of the past.  Cancer is no longer a death sentence.  We can replace most joints.  Organs can be substituted.  There are antibiotics.  Childhood diseases are rare. Most people live well past retirement.  There are drugs to treat almost every ailment.  We have x-rays, ultrasound, and magnetic resonance to see inside the body.  The myriad of treatment options goes on and on.

Added to all of the options for treatment is insurance.  Medicare and Medicaid began in 1965.  The first employer sponsored plan was in Texas in 1929, though most employer sponsored health insurance became available after WWII, blossoming in the 1950s.  With employers covering the cost of health care it is no suprise that insurance companies formed, drugs were developed, and health care solutions were found.

Now add the regulations and complexity of the health care industry.  Accreditations, licensure, HIPPA, equipment, regulations, billing insurances, to mention a few make the cost for health care rise for providers

Fast forward to 2012, were health care is 17% of GDP.  In the US we spent 2.5 trillion dollars on health care in 2009 and the amount grows annually. We are currently spending over $8,000 per year for every man, women, and child in the United States.

Have we created a monster?  Some would say yes. We have created a complex system that our citizens take full advantage of.  We seek preventive care, we have our joints replaced, we treat our cancers, we save our stroke victims. Is there a price for this? Absolutely!  Should it change?  That is the $60,000 question.  Most of us agree that it must.  And most of us are afraid of what that will mean for us personally.  As the country with the second highest cost of health care in the world, it is likely that change is essential.

Most employers are asking their employees to pay more toward the cost of their care.  Even public employees are being asked to contribute now. Each and everyone of us is going to be impacted by the growing cost of care.  Unfortunately, most of us have no idea what our individual health care really costs.  How many can cite what their care cost last year?  I believe very few; while most of us know how much we earned last year or how much we paid for our vacation.

Are we willing to accept less care?  Should we purchase based on price and perceived quality, like all other purchases we make?  Or is health care an entitlement?  These are just a few of the questions at the center of the debate and the answers are likely as complex as the questions.  More thoughts to come.

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