NY Times, September 7, 2014, by Pam Belluck
(The following are quotes from the Times article.)
Our
health care system is poorly designed to meet the needs of patients near the
end of life was the conclusion of a panel set up by the Institute of Medicine. ““The current system is geared towards doing
more, more, more, and that system by definition is not necessarily consistent
with what patients want, and is also more costly.”
The
panel called for “the elimination of “perverse financial incentives” that
encourage expensive hospital procedures when growing numbers of very sick and
very old patients want low-tech services like home health care and pain
management.
The
507-page report, “Dying
in America,” said its recommendations would improve the quality of care and
better satisfy more patients and families. It also said the changes would
produce significant savings that would help make health care more affordable.
“If
you meet their needs, treat their pain, treat their depression, get them some
help in the house, your costs plummet,” said Dr. Diane E. Meier, a committee
member and the director of the Center to Advance Palliative Care. Fewer
patients would end up in emergency rooms getting expensive care they do not
want, she said, adding, “It’s a rare example in health policy of doing well by
doing good.”
Perhaps,
the committee’s most “radical conclusion” was that there should be a more
pronounced shift away from fee-for-service medicine, which promotes an emphasis
on medical interventions in part by reimbursing doctors based on procedures
rather than for talking with patients.
In
surveys of doctors about their own end-of-life preferences, “a vast majority
want to be at home and as free of pain as possible, and yet that’s not what
doctors practice.
“Patients
don’t die in the manner they prefer,” Dr. Victor J. Dzau, the Institute of
Medicine’s president, said at the briefing. “The time is now for our nation to
develop a modernized end-of-life care system.”
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