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Nations, Civilized and Otherwise

First of all, RIP Melissa Mia Hall and condolences to her family, friends, and loved ones.

Second of all, I've been getting a closer-than-usual look at medical care and the paying for thereof here in the United States recently. That's likely to continue for an unknown amount of time, and even the things I've seen so far remind me of things that drive me crazy and angry at the US private insurance approach to paying for health care.

Horror stories are too easily found in any health care system, and heroic wins, too. Personal testimonials about the quality of care and the financial impacts (if any) don't tell the whole story, but they tell an important story. It's all the more important in an environment where the national rhetoric is completely out of touch with reality as it is here in the US.

And so I offer mevennen's post and the subsequent comments springing from Melissa Mia Hall's tragic death and the personal realities of health care systems in the UK, US, Canada, and other countries.

Speaking of civilized, I've been impressed with and in favor of hospice services ever since I first heard of them what had to have been decades ago. I970s or early '80s, I think. Over a late lunch at Arisia, geraty mentioned some surprising results reported in an New Yorker article on how end of life issues are handled by the traditional US medical system, and how they're handled in hospice programs. In particular, geraty talked about this:

"In late 2004, executives at Aetna, the insurance company, started an experiment. They knew that only a small percentage of the terminally ill ever halted efforts at curative treatment and enrolled in hospice, and that, when they did, it was usually not until the very end. So Aetna decided to let a group of policyholders with a life expectancy of less than a year receive hospice services without forgoing other treatments. A patient like Sara Monopoli could continue to try chemotherapy and radiation, and go to the hospital when she wished—but also have a hospice team at home focussing on what she needed for the best possible life now and for that morning when she might wake up unable to breathe. A two-year study of this “concurrent care” program found that enrolled patients were much more likely to use hospice: the figure leaped from twenty-six per cent to seventy per cent. That was no surprise, since they weren’t forced to give up anything. The surprising result was that they did give up things. They visited the emergency room almost half as often as the control patients did. Their use of hospitals and I.C.U.s dropped by more than two-thirds. Over-all costs fell by almost a quarter.

"This was stunning, and puzzling: it wasn’t obvious what made the approach work. Aetna ran a more modest concurrent-care program for a broader group of terminally ill patients. For these patients, the traditional hospice rules applied—in order to qualify for home hospice, they had to give up attempts at curative treatment. But, either way, they received phone calls from palliative-care nurses who offered to check in regularly and help them find services for anything from pain control to making out a living will. For these patients, too, hospice enrollment jumped to seventy per cent, and their use of hospital services dropped sharply. Among elderly patients, use of intensive-care units fell by more than eighty-five per cent. Satisfaction scores went way up. What was going on here? The program’s leaders had the impression that they had simply given patients someone experienced and knowledgeable to talk to about their daily needs. And somehow that was enough—just talking.

"The explanation strains credibility, but evidence for it has grown in recent years. Two-thirds of the terminal-cancer patients in the Coping with Cancer study reported having had no discussion with their doctors about their goals for end-of-life care, despite being, on average, just four months from death. But the third who did were far less likely to undergo cardiopulmonary resuscitation or be put on a ventilator or end up in an intensive-care unit. Two-thirds enrolled in hospice. These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. Moreover, six months after the patients died their family members were much less likely to experience persistent major depression. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish."

Entire article highly recommended, to be read preferably at a time before we, our loved ones, and friends need to be thinking about the subject in anything other than a philosophical manner.


( 4 comments — Leave a comment )
Feb. 7th, 2011 11:38 pm (UTC)
There was another good article about this in the New York Times today.

Cancer.net: http://www.cancer.net/patient/Coping/Advanced+Cancer+Care+Planning


Caring Connections: http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3277

Feb. 8th, 2011 12:38 am (UTC)
And I believe it was this kind of end-of-life planning and counseling -- "just talking" -- that the Palinites were calling "death panels" in the recent health care reform scrum.
Feb. 8th, 2011 08:19 am (UTC)
Ah, yup. Something known to bring comfort to people, significantly increase satisfaction of both patients and their families while also resulting in lower health care costs. Can't have that.
Feb. 9th, 2011 10:06 am (UTC)
Yes, well, those results are counterintuitive, not "common sense"....

Excellent article. Thanks for the pointer!
( 4 comments — Leave a comment )


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