Thursday, June 22, 2006
As a self-described skeptic, I love discussing challenges to common wisdom. I believe that is part of how I came to appreciate the field of palliative medicine so much. But there is also a common wisdom of palliative medicine that should not be immune to skepticism and questioning. After all that is how we make our field stronger.
A study out of the journal 'Applied Health Economics and Health Policy' came out with a unique analysis comparing ex ante mortality risk with actual end of life costs. While I do not have the article (I am working on it.....I can't find a source that actually has access to this article) for those of you who are interested in this, the authors looked at a retrospective calculation of mortality risk one year prior to death for Medicare beneficiaries. That mortality risk was compared to money was spent on health care at the end of life, and they found that they were inversely related.
Thus, those with the highest risk of dying actually had less money spent at the end of life, while those with the lowest retrospectively calculated mortality risk 1 year prior to death (i.e. those not expected to die) had a higher amount spent on them. The authors conclude that with current physician practice, palliative care's effect on cost saving may be less then previously thought.
Now again I have not read the article myself, and am still actively searching for it, but as loyal Pallimed readers should know from my previous post, I am not entirely excited at using the economic argument for implementation of palliative care. So a study like this might force our field to advocate for our services based on evidence of helping the patient/family unit and less on helping the system (although that could be a noble goal in itself, if it works towards preventing a collapse of health care).