Essay on Social Costs and Financial Risks: Expensive End-of-Life Care

Recent studies show that there has been a persistent rise in social costs and financial risks (Medicare, Medicaid, informal care, out-of-the-pocket spending, and private insurance) related to end-of-life care in the United States. Although slight variations exist across patients with acute conditions, data shows that older patients are increasingly paying more to secure medical services of prolonging their lives. Interestingly, scholars have found that there are limited chances of prolonging life of older patients suffering from acute illnesses even when the 'best' treatment techniques are employed. For instance, 60 percent of Medicare patients with poor cancer prognosis are hospitalized in their last month of life, and half of this number dies in hospital (Cassella, 2014). Research and health practitioners have suggested that technology has been responsible for the constant increase in the financial burden associated with medical services offered to older people.

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A majority of Americans at the twilight of the lives would prefer to die at home than in the hospital bed. This is because emotional therapy in hospice settings offers more satisfaction and dignity than remaining in the hospital in the company of high-tech medical equipment (Cassella, 2014).However, many older patients with terminal illnesses( some with a prognosis of less than six months) spend their dying moments in hospitals. Studies have estimated that at least 21.5 Medicare expenditure is channeled into end-of-life care and this figure continues to rise on a daily basis (Cassella, 2014). As such, patients not only fail to get what they want as they prepare for the end of their lives but also lack the much-needed quality care during this critical stage of life.

Enhanced technology in the medical field combines with several factors to generate this trend of sending dying patients to hospitals as opposed to hospice care. According to Cassella (2014) and Kekre (2012), the struggle among patients and physicians to transition to the next phase of life encourages the use of modern technologies to pursue aggressive treatment techniques for terminally-ill patients. Often, the family members struggle to find a balance of emotions regarding the impending death of a loved one. The lack of a trade-off between emotions and availability of financial resources motivates many families to opt for aggressive approaches to treating their sick relatives. Such situation invites technology to fill in the gap created by the lack of better approaches to treating older patients with acute illnesses.

Considerable literature shows that procuring treatment through high-tech means has led to the astronomical rise in the cost of end-of-life care. According to Norbeck (2012), the development of knee replacement technologies has led to a 161.5% rise in knee surgeries over the last two decades. In 2010, patients aged at least 65 underwent surgeries to replace knees or revise previous operations. This number is expected to rise as the American population age. In the same breadth, technological development in the treatment of cardiovascular diseases has resulted in increased expenditures by people seeking treatment for heart-related conditions. For instance, patients with valvular disease used to undergo surgical aortic valve replacement procedure to treat the disease. However, technological advancement has led to the rise of Transcatheter aortic valve implantation as a treatment of choice for many patients. Yet the disease mostly affects older people, and the cost of the new treatment is very high (Wijeysundra et al., 2016).

Technological development in health care is a good thing. For instance, technological innovations such as lasers and robots in health care have brought many advantages to patients. First, innovation allows physicians to make better diagnoses and manage acute conditions of older patients (Kekre, 2012). Specifically, innovation has been very effective in easing pain thereby improving the quality of life of aging patients (Norbeck, 2012). However, Kokre (2012) observes that technological innovations in health care are likely to be subjected to abuse by medical practitioners. As indicated earlier, the push by relatives to seek for high-tech treatment is partly motivated by the availability of abundant financial resources in terms of family wealth and the intention to exhaust limits of medical insurance programs. What is, then, the optimum interaction between treatment needs and application of technological innovation? What is the cost-effective way of treating aging patients?

Some medical practitioners have suggested that expanding access to palliative care programs can play a significant role in reducing end-of-life care costs. Under this platform, various players such as nurses, doctors, clergy, and social workers forge a common ground through which counseling services to older patients and their family members are offered. Such concerted effort not only equips patients with knowledge on how to cope with emotions at the end of their lives but also allows family members of elderly patients to psychologically prepare themselves for the impending death of their loved ones (Cassella, 2014). This way, cultural practices that espouse extreme resolve to save lives at all costs would be discouraged.

Focusing on the needs of patients can go a long way in addressing the widespread practice of seeking aggressive medical treatment for older patients. Physicians and nurses should be willing to share information with family members in regards to the extreme emotional and physical consequences of subjecting end-of-life patients to ICU care, respirators, and hybrid drugs. Sharing of information would also enable families to understand that aggressive treatment does not bring much difference to the life of the patients. As evidence suggests, patients treated under aggressive conditions live no longer than those treated with minimal interventions or attended to in hospice settings (Cassella, 2014).

Conclusion

Aggressive treatment does not improve the health outcomes of patients in the twilight stage of their lives. Despite the substantial benefits that come with technology, caution should be observed when treating older patients with acute illness. Evidence suggests that effective information exchange among physicians, family members, and patients can make a difference in the lives of older patients, especially when complemented with hospice care. Such intervention would enable older patients to die in dignity.

References

Cassella, C. (2014). How can we reduce end-of-life health-care costs? The Wall Street journal.

Kekre, N. (2012). The rise and rise of technology in urology- Cost-effective medicine vs. new treatments. Indian Journal of Urology, 28(4), 375. doi:10.4103/0970-1591.105742

Norbeck, T. B. (2012). Drivers of Health Care Costs. Retrieved from The Physicians Foundation website: http://www.physiciansfoundation.org/uploads/default/Drivers_of_Health_Care_Costs_-_November_2012.pdf

Wijeysundera, H. C., Li, L., Braga, V., Pazhaniappan, N., Pardhan, A. M., Lian, D. Kingsbury, K. J. (2016). Drivers of healthcare costs associated with the episode of care for surgical aortic valve replacement versus transcatheter aortic valve implantation. Open Heart, 3(2), e000468. doi:10.1136/openhrt-2016-000468