End-Of-Life: Cost of Care (part 3 of 5) Statistics on the cost of cancer care are eye-opening: A third of the cost of treating cancer occurs in the final year, 78% of which occurs in the final month of life. An unsettled issue is: Should the cost of end-of-life care be discussed with patients and their families? Certainly, oncologists (and medical publications) should discuss cost and risks of various treatment approaches. With the new center for Comparative Effectiveness Research (CER), such data will have the stamp of scientific research. Knowing the effectiveness and economics of various alternatives will help doctors and hospitals practice more responsibly and accept, or counter directives from insurers who are being positioned as “health-managers” rather than “health-insurance” entities. The Dartmouth Atlas Project reports that the average expenditure at the end-of-life ranges from about $54,000 at the Mayo Clinic and Cleveland Clinic, to more than $93,000 at UCLA, Cedars-Sinai, and New York University Medical Center. Planners are confounded by such variations in the practice-patterns and cost, which produce similar outcomes. The cost-comparison of these top hospitals discounts such variables as high technology, expensive drugs, and procedures as unavoidable culprits of high costs. Using accepted benchmark endpoints, the "low-cost" hospitals provided better care. Dr. Gawande, in his much publicized study in the New Yorker magazine, drew a similar conclusion; when he compared healthcare in McAllenwith neighboring El Paso, Texas. Medical care delivered in the Midwestern states cost a lot less; with no data to suggest that these states deliver care inferior to that delivered in states east of the Mississippi. Because one in four deaths is cancer-related, addressing end-of-life care in cancer patients will see an immediate improvement in over-all healthcare costs. In addition to insurance-paid healthcare costs, there are personal costs. From a financial perspective, of the more than a million individuals who declare personal bankruptcy every year, Harvard researchers report 62% are caused by healthcare costs; with 78% having insurance and belonging to the middle-class at the start of their illness. Meeting Patient's and Society's goals 4/5 part next Regards, GL
