View Full Version : If you work in healthcare: single payer system
iris lilies
5-31-16, 12:48pm
We have many nurses and health care workers here.
Tell me your idea of how a federal government single payer system would affect your rate of pay, your raises, your benefits, your working conditions.
You need to ask someone who works at the VA or another type of government medical facility what their pay and benefits are and what they think of working conditions. It is also interesting to see some of the information about the NHS in the UK and its early history and current status.
Ultralight
5-31-16, 1:17pm
Nurses in Canada make about $10 USD per hour and they get no vacation time or dental/vision insurance. They obviously get gubmint healthcare, but since they work in it and know how bad it is they all come to the US to see doctors here.
Sad, really, how bad Canadians and their nurses have it up there.
iris lilies
5-31-16, 1:34pm
Nurses in Canada make about $10 USD per hour and they get no vacation time or dental/vision insurance. They obviously get gubmint healthcare, but since they work in it and know how bad it is they all come to the US to see doctors here.
Sad, really, how bad Canadians and their nurses have it up there.
I guess this is another sarcastic post with hyperbole presented as faux fact. I guess. Hard to know..
This doesnt add anything to this discussion but thanks anyway.
A friend worked briefly at the beleaguered St. Louis VA hospital and was horrified, and
I am not using that adjective lightly, at what she saw in the lack of standards. She got outta there quickly.
Ultralight
5-31-16, 1:36pm
Serious:
RNs in Canada make between $28 an hour and $41 and hour.
iris lilies
5-31-16, 1:37pm
Serious:
RNs in Canada make between $28 an hour and $41 and hour.would that be US or Cdn?
Ultralight
5-31-16, 1:38pm
Canadian dollars.
One Canadian Dollar equals $.76 USD at the moment.
Ultralight
5-31-16, 1:40pm
But if you factor in taxes, then Canadian nurses are only bringing home bread and water from the Communist Despots who run their healthcare and tax all their wages away.
Nurses in Canada make about $10 USD per hour and they get no vacation time or dental/vision insurance. They obviously get gubmint healthcare, but since they work in it and know how bad it is they all come to the US to see doctors here.
Sad, really, how bad Canadians and their nurses have it up there.
Where are you getting your info, UL?
The personal support workers, PSW's, may earn C$15-20/hr but RN's and RPN's make a lot more. A lot of healthcare service is now provided by contractors which do not offer significant benefit packages to their workers but many still have employment with benefits in their jobs.
One-payer healthcare does work well until everyone wants everything covered. So many drugs are of no benefit but very costly. If a single payer system was understood to cover basic care and everything else is optional and pay-per-use it might survive, IMHO anyway.
Ultralight
5-31-16, 1:43pm
The personal support workers, PSW's, may earn C$15-20/hr but RN's and RPN's make a lot more.
Yeah, right! You actually believe the propaganda that comes out from all the communist despots that run your country! I have been to Canada and I can tell you it is little more than a snowy banana republic!
iris lilies
5-31-16, 1:53pm
...One-payer healthcare does work well until everyone wants everything covered. So many drugs are of no benefit but very costly. If a single payer system was understood to cover basic care and everything else is optional and pay-per-use it might survive, IMHO anyway.
i am amazed that some (all?) provinces will pay for invitro fertilization.
That is a costly little thing that I am glad my insurance collective does not pay for though I suppose its only a matter of time before our Prez declares it anti-woman to deny payment for it, and invitro is added to the long ACA list of mandatory coverage.
[sarcasm] Its just right and fair that eveyone get medical treatment to make them the same as everybody else, give all a level playing field, doncha know. Fertility inequity is wrong! Just let Nanny G fix it.[/saracsm]
I'm not sure how much it's changed - but I largely grew up under single payer. Air Force brat. My knee surgeries were not state of the art (arthroscopy was still pretty new, so I have 10" long incisions on both knees instead of small scars), but they've worked fine since.
I was a pharmacist at the VA hospital in Houston for 3 years but it was 25 years ago. I was impressed with the caring nurses there, but I've always been impressed by the caring nurses. The patients received good care for their mostly chronic conditions but the wait times were very long. I left for more $$$.
iris lilies
5-31-16, 2:15pm
I was a pharmacist at the VA hospital in Houston for 3 years but it was 25 years ago. I was impressed with the caring nurses there, but I've always been impressed by the caring nurses. The patients received good care for their mostly chronic conditions but the wait times were very long. I left for more $$$.
In Bernie's paradise, would you be able to leave one place for another for more money?
Ultralight
5-31-16, 2:24pm
In Bernie's paradise, would you be able to leave one place for another for more money?
No, you'd have to work wherever the Commissar of Labor told you to work.
Ultralight
5-31-16, 2:31pm
Remember, nurses in Canada and other commie nations are not allowed to change jobs or seek promotions (they don't have promotions in communism!).
So basically after nursing school you have to work where the Commissar says until you are 75, at which point you retire to a labor camp for old folks.
Teacher Terry
5-31-16, 2:36pm
I know someone that has worked at the VA here for the past 25 years. She is a psychiatric nurse with a master's and has made over 100K the past 16 years I have known her. I am shocked that Canada would pay for such an expensive optional procedure such as that. I would not be for that type of thing. Having kids is definitely optional and either you can afford it or you can't.
Yeah, right! You actually believe the propaganda that comes out from all the communist despots that run your country! I have been to Canada and I can tell you it is little more than a snowy banana republic!
My mistake. I thought that we were having a conversation about important issues. Sorry!
Ultralight
5-31-16, 3:02pm
My mistake. I thought that we were having a conversation about important issues. Sorry!
We are!
iris lilies
5-31-16, 3:10pm
I know someone that has worked at the VA here for the past 25 years. She is a psychiatric nurse with a master's and has made over 100K the past 16 years I have known her. I am shocked that Canada would pay for such an expensive optional procedure such as that. I would not be for that type of thing. Having kids is definitely optional and either you can afford it or you can't.
"It's the right thing to do..." Says Kerry Bowman, a medical ethicist quoted in an article I read about Ontario paying for in vitro.
So get used to it, when its the right thing to do, fagettabout practical aspects like how to fund it. We've got a lot of that coming our way in Bernie's paradise.
Also, as an aside, I do not understand why in vitro procedures in the U.S. are so very expensive when insurance companies are not, for the most part, involved. Generally speaking, health insurance companies do not pay for in vitro treatments. If there are no fat middlemen to skim profit from these treatments, why so expensive?
Ultralight
5-31-16, 3:12pm
Bernie's paradise.
There ain't going to be no Bernie's Paradise. We'll be lucky to get a weekend there.
I see Colorado will be holding a referendum on a Statewide single payer plan. They plan on paying for it with a 10% payroll tax.
Ultralight
5-31-16, 3:13pm
Also, as an aside, I do not understand why in vitro procedures in the U.S. are so very expensive when insurance companies are not, for the most part, involved. Generally speaking, health insurance companies do not pay for in vitro treatments. If there are no fat middlemen to skim profit from these treatments, why so expensive?
I am not even sure why they are needed.
Ultralight
5-31-16, 3:13pm
I see Colorado will be holding a referendum on a Statewide single payer plan. They plan on paying for it with a 10% payroll tax.
This will get laughed right out of town.
iris lilies
5-31-16, 3:15pm
We are!
You've been standIng outside the conversation taking pot shots.
Good luck with that strategy.
This will get laughed right out of town.
You're probably right. Since pot is legal there I'm sure there are all sorts of things causing giggling fits...
Ultralight
5-31-16, 3:19pm
You're probably right. Since pot is legal there I'm sure there are all sorts of things causing giggling fits...
Workers voted down there own sick days there a couple years ago.
iris lilies
5-31-16, 3:24pm
Workers voted down there own sick days there a couple years ago.
The Kansas Effect in action. The stupid Proles dont know whats good for them.
Ultralight
5-31-16, 3:27pm
The Kansas Effect in action. The stupid Proles dont know whats good for them.
I would not phrase it that way. There is a mean-spirited tone in that turn of phrase.
iris lilies
5-31-16, 3:27pm
I am not even sure why they are needed.
Why what is needed, fertility treatments or public funding of same?
iris lilies
5-31-16, 3:32pm
I would not phrase it that way. There is a mean-spirited tone in that turn of phrase.
Good. I'm glad you do not think they are stupid. Neither do I although
I know nothing about the ballot issue you speak of and assume it was mandating paid sick leave or some other sick leave benefit.
However, the author of Whats the Matter with Kansas? did show his disdain for the proles in flyover country who unfathomably voted down social benefits that worked in their favor.
He could not grok it.
iris lilies
5-31-16, 3:37pm
There ain't going to be no Bernie's Paradise. We'll be lucky to get a weekend there.
Haha and ok, I will tone down my "Bernie's paradise " rhetoric.
Ultralight
5-31-16, 3:38pm
Good. I'm glad you do not think they are stupid. Neither do I although
I know nothing about the ballot issue you speak of and assume it was mandating paid sick leave or some other sick leave benefit.
However, the author of Whats the Matter with Kansas? did show his disdain for the proles in flyover country who unfathomably voted down social benefits that worked in their favor.
He could not grok it.
I'd call them creatures of propaganda, to quote Jacques Ellul.
Ultralight
5-31-16, 3:39pm
Haha and ok, I will tone down my "Bernie's paradise " rhetoric.
No need to tone it down. haha
It is just misleading. I don't want to get my hopes up for a Bernie's Paradise that will never come close to existing!
Good. I'm glad you do not think they are stupid. Neither do I although
I know nothing about the ballot issue you speak of and assume it was mandating paid sick leave or some other sick leave benefit.
However, the author of Whats the Matter with Kansas? did show his disdain for the proles in flyover country who unfathomably voted down social benefits that worked in their favor.
He could not grok it.
Thomas Frank has a new book out taking Democrats to task for being insufficiently liberal. It's good to know he's an equal opportunity scold.
Ultralight
5-31-16, 5:59pm
Thomas Frank has a new book out taking Democrats to task for being insufficiently liberal. It's good to know he's an equal opportunity scold.
Liberals have been saying this for years. Dems are DINOs.
freshstart
5-31-16, 6:14pm
Back to the OT, as a nurse, I am all for a single-payer system from a patient's perspective and as an employee. I don't think salaries would get much lower than they already are and I would welcome working for the gov't, getting that pension and level of benefits. Our VA nurses make a lot more than non-VA staff and have much better bennies. However, the hospital is woefully staffed and way over-taxed with veterans' needs.
Back in the 90s I hired a Canadian RN. She liked being a RN there. Families were expected to be heavily involved in care-its part of what kept cost down. Family brings personal care items, bed and bath linens. AND they provide that level of care. RN's provided care that required their license and expertise. Time was spent with patients and documentation in the record was nominal. Care was high quality and expectations were met.
Here? Far fewer patients, no family involvement, tons of documentation......
She felt pay was satisfactory there and here.
The VA here pays higher than my facility. Federal retirement benefits, healthcare, and retirement appeals to many. RN's tend to go there for the final 5 working years which is the fully vetted benefit status.
Do I believe in a single payor system? Well, what I believe is that we need insurance reform and since we as a country won't do that I am in support of a single payor system. I don't think anything else will truly bring the cost of healthcare under control.
We do far too much in this country for far too many. 80% of healthcare dollars are spent in the final 30days of life. Doesn't matter if this is a newborn or a 100yo, trauma victim or "natural" death.
People in this country want EVERYTHING. And they want it NOW. And they want it done by someone else and paid for by someone else. We cannot sustain this insanity.
My brother nearly lost his foot 18y go in a farm accident. He had 4 surgeries in 5d and then home on bedrest. He was happy to have his foot. He was pisssed when he got the $40,000 bill. Me: "they saved your foot. you had 4 surgeries w anesthesia. you spent 5d in the hospital. They could have amputated it, and sent you home and that could have cost a lot less. You want Mercedes healthcare for a Volkswagen price?" Yes, he had great insurance that covered their 80%.
Mom was diagnosed w/bladder cancer back in '07. My sister and I took her home and cared for her w/hospice assistance. Nov3-Dec 23. Got the final medicare report in February. Total cost of her end of life care? Just under $2700. That included all medical equipment, meds and anything else I asked for. That is less than 2d in the hospital.
Dad back in 1994. Lung cancer. Cared for at home w/in house hospice when he got really bad (very different cancer death). Also all covered by Medicare and mighty cheaply.
Why do we as a culture take no responsibility for our healthcare?
Oh my, you've hit my soapbox.
AND, I have no respect for the potshots Ultralight. You seem to have no knowledge of what you speak. I think the OP was seriously asking a question. How about some real dialogue.........
And thank you FreshStart for your perspective as well.
i am amazed that some (all?) provinces will pay for invitro fertilization.
That is a costly little thing that I am glad my insurance collective does not pay for though I suppose its only a matter of time before our Prez declares it anti-woman to deny payment for it, and invitro is added to the long ACA list of mandatory coverage.
[sarcasm] Its just right and fair that eveyone get medical treatment to make them the same as everybody else, give all a level playing field, doncha know. Fertility inequity is wrong! Just let Nanny G fix it.[/saracsm]
I don't know about IVF being covered as it hasn't come up in my circle, so I'm assuming you are correct but on the other hand permanent sterilization is also covered, which is awesome. Though odd that other birth control options aren't (under the government plan anyhow; different under private extended health plans). Free surgery and then no cost for birth control or having kids. Win-win.
Thank you Gardnr, I have no issue paying some of my medical care, I cover dental work, glasses, and other things. My health insurance takes the edge off of it. I get frustrated at times because I do pay for health insurance every month however.
I have a good friend from Canada whose ex-MIL is a nurse up there. She seems to be doing fine financially, she certainly is able to pay all her bills and will be able to retire. My friend has had a hard time in this country (it has been about 16 years) because the cost of medical procedures is so high she is paying off things for years. She will admit that not everything is perfect in Canada but she is more conservative than I am and supports some version of state health care support.
UA, what the heck are you trying to say? I find it very distracting, and quite irritating today.
While I do think we each have a personal responsibility for basic healthcare, one of the great things about the ACA (which I do absolutely support), is that basic prevention is mandatory 100% covered by the insurance company. They must provide all nationally recommended preventive screenings such as: Mammography annual after age 50, colonoscopy every 5y after age 50 (catch a polyp early via scope vs colon cancer/surgery/chemo later), basic health visit/routine blood work annually....these are all good things. Does everyone do them? I doubt it but they pay for it in their insurance premiums. It's like flushing $100 bills down the toilet every year if you don't.
Do you know what your fasting glucose is? You should. (pre diabetes possible if over 100)
History of breast of colon cancer in your family? You really should get the screenings
Men Prostate exam after age 50? PSA?
Do you know what your Blood Pressure is? (risk of stroke if high).
Failing to know the above and/or not taking action contributes significantly to the cost of healthcare in this country. Taking full advantage of 100% covered preventive exams can derail most of the above listed items.
about 80% of healthcare going towards the last 30 days of life, often for an elderly person with no reasonable chance of recovery, that's where the hospice conversation should be had. The majority of the time, the dying person was so grateful to be home, it didn't matter if they died the next day. I don't think hospice brands itself well nationally, if more people understood it's not just "giving up", I think more people would choose it. Locally, we do some advertising and community reach out but not nearly enough.
Williamsmith
6-1-16, 8:29am
I couldn't agree more freshstart. My community embraces hospice as a blessing. Many hard working middleclass and poor families understand that life comes to an end. They are not looking to spend one hundred thousand dollars extending their life by a week or even a month. They look only for dignity in their death without bankrupting their heirs. Hospice is an "angelic" organization. I truly believe in their mission and I also believe that if someone or thing is keeping score, these people are in the Hall of Fame.
I would assume that in Colorado's case "single payer" means single payer with no alternatives allowed. But that wouldn't be the first time a law's title and intent were at variance.
Depending on the plan design, there would be winners and losers all over the place, both among employers and plan participants. There might be some degree of adverse selection if there were an influx of people seeking coverage with minimal taxable compensation and an outflow of highly compensated people and high-paying employers who didn't require locations in Colorado. These things can be very complicated. That's what makes it so interesting.
iris lilies
6-1-16, 10:01am
about 80% of healthcare going towards the last 30 days of life, often for an elderly person with no reasonable chance of recovery....
This where I look forward to death panels. I'm not being a smart alec here. Many times
Ive said that if we are compelled to march futher into government controlled and supported health care territory, we had bloody well better set up those panels now to control costs. The grown ups in the government must take charge, we cant let a family with no financial skin in the game insist on three weeks of intensive ICU and therapies for granny when she is beyond recovery.
But I have little faith that Congress will make that happen, they have been unable to step up to be grownups in the past.
I've heard that the Socialist countries ya'll love to emulate do not have these long drawn out end of life expenses, but i dont know how true that is. This is yet another cultural difference between them and us, Americans want it bigger, better, life longer, more expensive. I would bet that they arent in competition for saving the smallest premie babies in those other countries either.
What Gardnr said about families providing much more to the patient than here is nteresting, and n doubt there are all onds of cultural differences at work n single payer country health institutions.
This where I look forward to death panels. I'm not being a smart alec here. Many times
Ive said that if we are compelled to march futher into government controlled and supported health care territory, we had bloody well better set up those panels now to control costs. The grown ups in the government must take charge, we cant let a family with no financial skin in the game insist on three weeks of intensive ICU and therapies for granny when she is beyond recovery.
But I have little faith that Congress will make that happen, they have been unable to step up to be grownups in the past.
I've heard that the Socialist countries ya'll love to emulate do not have these long drawn out end of life expenses, but i dont know how true that is. This is yet another cultural difference between them and us, Americans want it bigger, better, life longer, more expensive. I would bet that they arent in competition for saving the smallest premie babies in those other countries either.
What Gardnr said about families providing much more to the patient than here is nteresting, and n doubt there are all onds of cultural differences at work n single payer country health institutions.
I would have to assume that giving government (or markets, or government/market hybrids) the power to ration health care inevitably must result in some formal or informal version of death panels.
UA, what the heck are you trying to say? I find it very distracting, and quite irritating today.
I get the impression that ULA is channeling Stephen Colbert today.
Ultralight
6-1-16, 11:06am
I get the impression that ULA is channeling Stephen Colbert today.
The ability to pick up on sarcasm is a mark of high intelligence.
The ability to pick up on sarcasm is a mark of high intelligence.
Sarcasm is difficult to translate into print. Therefore it should only be attempted by skilled professionals.
I forget who it was who said "A sneer is the weapon of the weak".
iris lilies
6-1-16, 11:18am
The ability to pick up on sarcasm is a mark of high intelligence.
Or, its a mark of too much internet time.
ask me how I know! :~)
Ultralight
6-1-16, 11:22am
Sarcasm is difficult to translate into print. Therefore it should only be attempted by skilled professionals.
I forget who it was who said "A sneer is the weapon of the weak".
As an American workin' schlub who wants single-payer, universal healthcare I would say I am indeed weak.
Ultralight
6-1-16, 11:23am
Or, its a mark of too much internet time.
Guilty! Well, sort of. I don't have a lot of time. But it is all I can do to keep my mind from going totally numb. haha
I couldn't agree more freshstart. My community embraces hospice as a blessing. Many hard working middleclass and poor families understand that life comes to an end. They are not looking to spend one hundred thousand dollars extending their life by a week or even a month. They look only for dignity in their death without bankrupting their heirs. Hospice is an "angelic" organization. I truly believe in their mission and I also believe that if someone or thing is keeping score, these people are in the Hall of Fame.
we've actually found that poor and minority communities use us less than other population groups. There has been some discussion of whether this is because they feel pushed into hospice specifically to save their insurance company money. Like we are just pushing them off to go away and die. We have terrible numbers in the African-American and Muslim communities and that is where we are trying to do more reaching out.
Williamsmith
6-1-16, 1:36pm
we've actually found that poor and minority communities use us less than other population groups. There has been some discussion of whether this is because they feel pushed into hospice specifically to save their insurance company money. Like we are just pushing them off to go away and die. We have terrible numbers in the African-American and Muslim communities and that is where we are trying to do more reaching out.
Not an expert but I suspect that hospice care and law enforcement experiences overlap a little. So my perception is that minority neighborhoods are less socially integrated, more isolated and are used to lacking resources. They actively guard against outsiders, shun them and require high levels of proof of honest intentions before acceptance into the community.
So, it is a factor of resource starvation and fear of being taken advantage of.
iris lilies
6-1-16, 2:48pm
we've actually found that poor and minority communities use us less than other population groups. There has been some discussion of whether this is because they feel pushed into hospice specifically to save their insurance company money. Like we are just pushing them off to go away and die. We have terrible numbers in the African-American and Muslim communities and that is where we are trying to do more reaching out.
Some reasons
1) no financial skin in the game, make whitey pay
2) different values about quality of life
3) lack of what I consider "sophistication" about what modern medicine can really do-p at end of life or for severly compromised accident victims and premature infants and etc. But this could really just be another cultural value difference
The tv educated really think docs and hospitals can pull miracles out of their asses for great recoveries.
make whitey pay
Please explain further.
Not an expert but I suspect that hospice care and law enforcement experiences overlap a little. So my perception is that minority neighborhoods are less socially integrated, more isolated and are used to lacking resources. They actively guard against outsiders, shun them and require high levels of proof of honest intentions before acceptance into the community.
So, it is a factor of resource starvation and fear of being taken advantage of.
You nailed it
As for death panels, I don't even think we need them if doctors will speak more openly about death. Somewhere sound .5% of advanced cancer patients will even survive resuscitation and those that do end up on a vent never to come off. If oncologists shared this info readily, more end stage cancer patients would choose DNR and hopefully hospice. There are similar stats for other end stage diseases.
iris lilies
6-1-16, 3:15pm
Please explain further.
The Man, The System, has all the monies. Make them use it because we are just as good as they are.
I tell my sister, who would likely be making the call, that when it comes to my death "pull the plug with extreme prejudice!"
The Man, The System, has all the monies. Make them use it because we are just as good as they are.
A little more detail please, especially the "whitey" part.
iris lilies
6-1-16, 3:19pm
A little more detail please, especially the "whitey" part.
whitey is The Man, The System. Interchangeable terms.
whitey is The Man, The System. Interchangeable terms.
"Whitey" makes it sound like there are some racial implications. Are there?
iris lilies
6-1-16, 3:21pm
"Whitey" makes it sound like there are some racial implications. Are there?
Do you think The Man and The System employ equal opportunity in the eyes of poor African Americans?
Do you think The Man and The System employ equal opportunity in the eyes of poor African Americans?
Not just going to answer my questions, I see.
Look, I am not going to go on a what you might perceive as a liberal tirade about racism in this nation. I just wanted to get a more detailed explanation of what you meant.
And if I think something you say is racist or that if you are racist, oh well. I think lots and lots of people are racist -- even many lefties who swear they ain't!
iris lilies
6-1-16, 3:33pm
Not just going to answer my questions, I see.
Look, I am not going to go on a what you might perceive as a liberal tirade about racism in this nation. I just wanted to get a more detailed explanation of what you meant.
And if I think something you say is racist or that if you are racist, oh well. I think lots and lots of people are racist -- even many lefties who swear they ain't!
hunh? Of course there are racial implications in a conversation about racial factors in using a societal service such as hospice.
Would you make your "make whitey pay!" remark if this forum were 95% black folks?
iris lilies
6-1-16, 3:47pm
Would you make your "make whitey pay!" remark if this forum were 95% black folks?
Thats a theoretical that is unlikely. But if it were a group I knew WELL--maybe.
Thats a theoretical that is unlikely. But it is a group I knew WELL--maybe.
Would you make that whitey comment around 3 or 4 black folks you barely knew?
iris lilies
6-1-16, 3:49pm
Would you make that whitey comment around 3 or 4 black folks you barely knew?
nope.
edited to add: I might, if having a serious conversation with a group of strangers like a focus group about lack of African American usage of hospice services, comment that its my impressin that making "whitey or The Man or The System" pay is part of that consciousness.
It depends on why we as a grou,are togehter, how serious is the social gathering.
iris lilies
6-1-16, 3:57pm
Why not?
Read my edited answer. It depends on if a group were truly investgating a social problem of low use of hospice, or if people were just standing around at a cocktail party.
Most social situations are not worth offending someone.
Teacher Terry
6-1-16, 5:29pm
People are afraid to face their own death. A few that i have known have sworn they would not do chemo if it was hopeless yet when it happens they choose it.
People are afraid to face their own death. A few that i have known have sworn they would not do chemo if it was hopeless yet when it happens they choose it.
Suffering scares me.
I was sick enough before (twice actually) that I thought I would die. Death did not worry me. I did not consider religion. I just wanted to tie up a few loose ends and then check out painlessly as possible.
Teacher Terry
6-1-16, 5:47pm
I thought everyone might find this interesting about how the US compares to other countries on the cost of end of life care.
Cost of End-of-Life Care in the U.S. is Comparable to Europe and Canada, Finds New Penn Study First Analysis of the Differences in Treatment and Costs of End-of-Life Care Among Developed Countries Shows Room for Improvement Across the Board
PHILADELPHIA – Despite widespread perception, the United States does not provide the worst end-of-life care in the world. In the first international comparison of end-of-life care practices, researchers from the Perelman School of Medicine at the University of Pennsylvania (http://www.med.upenn.edu/)and colleagues from seven countries found that the United States actually has the lowest proportion of deaths in the hospital and the lowest number of days in the hospital in the last six months of life among the those countries, according to a new study published today in JAMA (http://jama.jamanetwork.com/journal.aspx).
Related Links Perelman School of Medicine at the University of Pennsylvania (http://www.med.upenn.edu)
University of Pennsylvania Health System (http://www.pennmedicine.org)
However, the United States performs poorly in other aspects of end-of-life care, especially related to high-technology interventions. Over 40 percent of patients who die with cancer are admitted to the intensive care unit (ICU) in the last six months of life, which is more than twice that of any other country in the study. Similarly, 39 percent of American patients dying with cancer received at least one chemotherapy treatment in the last six months of life more than any other country in the study.
Using data from 2010 to 2012, researchers compared the site of death, treatments, and care used, as well as hospital expenses during the last six months of life for 389,073 patients who died in seven countries: Belgium, Canada, England, Germany, the Netherlands, Norway and the U.S. In Belgium and Canada over 50 percent of patients died in the hospital, while in England, Norway, and Germany over 38 percent of patients died in the hospital. By comparison in the U.S. 22 percent, and in the Netherlands 29 percent of cancer patients died in the hospital, which is in accordance with most patients’ wishes.
“There’s a widespread perception that the U.S. spends a tremendous amount on end-of-life care, but until now there’s never been a comparative study to put U.S. spending and resource utilization in context,” said senior author Ezekiel J. Emanuel, MD, PhD (http://medicalethics.med.upenn.edu/people/faculty/ezekiel-j-emanuel), Vice Provost for Global Initiatives, the Diane vS. Levy and Robert M. Levy University Professor, and chair of the Department of Medical Ethics and Health Policy at Penn. “End-of-life care is intensive and expensive, and what we know now is that the US does not have the worst end-of-life care and that no country is optimal. All countries have deficits.”
Spending on end-of-life care was high in the U.S. at about $18,500 for hospital care in the last six months of life. Canada and Norway were even higher at $21,840 and $19,783 per patient, respectively, while Belgium, England, and the Netherlands were lower at $15,699, $9,342, and $10,936, respectively.
Importantly, these results suggest reasons for optimism, suggests Emanuel: “Care for patients dying with cancer has improved. As the U.S. shows it is possible to change care. In the early 1980s over 70 percent of patients with cancer died in the hospital and spending many days in the hospital was common. We can improve care and now countries need to commit to improving that care.”
“Every country has its own challenges to improve end-of-life care. There are still too many people with cancer dying in acute care hospitals when we know our patients prefer to die at home,” said Justin E. Bekelman, MD (http://www.med.upenn.edu/apps/faculty/index.php/g275/p8199210), an associate professor of Radiation Oncology and Medical Ethics and Health Policy, and lead author of the new study. “The U.S. continues to have high rates of ICU admissions and other markers of care intensity near the end of life. We can do better. We need a concerted effort toward making end-of-life care more consistent with our patients’ wishes.”
Using the results of this paper as a baseline for end-of-life care in the U.S. compared to other countries, the authors say moving forward it will be important for studies to focus on the cost of care outside of the hospital and better understanding the drivers of health care utilization disparities.
“This study focuses only on patients with cancer and mainly on their hospital services,” Emanuel said. “To really understand the costs and to develop new models for improved delivery of end-of-life care, we need a prospective study to evaluate three things: dying patients with other diseases, the full range of care both in and out of the hospital, and most importantly, the quality of that care.”
The study was funded by the National Institute on Aging (P01-AG19783), the National Cancer Institute (KO7CA163616), and the Commonwealth Fund (20130502).
Penn Medicineis one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of theRaymond and Ruth Perelman School of Medicine at the University of Pennsylvania (http://www.med.upenn.edu/) (founded in 1765 as the nation's first medical school) and theUniversity of Pennsylvania Health System (http://www.pennmedicine.org/), which together form a $5.3 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 18 years, according toU.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $373 million awarded in the 2015 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals byU.S. News & World Report-- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2015, Penn Medicine provided $253.3 million to benefit our community.
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iris lilies
6-1-16, 5:55pm
People are afraid to face their own death. A few that i have known have sworn they would not do chemo if it was hopeless yet when it happens they choose it.
i wont swear, but I would want a very pointed estimate of recovery chances. I am definately on the side of "giving in."
It is so complicated, ugh. A fellow we know recently succumbed to lung cancer. He was ready to die, his dipshit sister drug his mother and various other family from out of state to visit him. A last goodbye. They sat around his bedside crying and urging him to "fight." He gave in, had a feeding tube installed, they left town. That feeding tube caused problems and pain, he had allergic reactions to morpine ao,that asnt much help, it all just prolonged his agony.
So not worth it.
i wont swear, but I would want a very pointed estimate of recovery chances. I am definately on the side of "giving in."
It is so complicated, ugh. A fellow we know recently succumbed to lung cancer. He was ready to die, his dipshit sister drug his mother and various other family from out of state to visit him. A last goodbye. They sat around his bedside crying and urging him to "fight." He gave in, had a feeding tube installed, they left town. That feeding tube caused problems and pain, he had allergic reactions to morpine ao,that asnt much help, it all just prolonged his agony.
So not worth it.
With you on this! Pull the plug with extreme prejudice!
I trust my sis on this. She is very science and evidence-based. She won't sit around thinking: "A miracle could happen!"
She'd be like: "He said pulling friggin' plug!"
iris lilies
6-1-16, 6:10pm
With you on this! Pull the plug with extreme prejudice!
I trust my sis on this. She is very science and evidence-based. She won't sit around thinking: "A miracle could happen!"
She'd be like: "He said pulling friggin'plug!"
i dont know if you have heard my story on this, but: my brother is rational and is in Health care. For a while I toyed with the idea of having him be my medical POA rather than DH
because I observed DH too often unable/unwilling to euthanize our dogs when it was time. I always had to make the damned decision.
when I presented ths idea to my brother he said: sure, fine. But in most all circumstances the piece of paper is worthless and a medical professional will look to your DH for these plug pulling decisions.
Fortumqtely,, DH has seemed to come around and now I regularly drill him on my thoughts about plug pulling and I emphasize NO feeding NO hydratin tube lots of morphne.
i dont know if you have heard my story on this, but: my brother is rational and is in Health care. For a while I toyed with the idea of having him be my medical POA rather than DH
because I observed DH too often unable/unwilling to euthanize our dogs when it was time. I always had to make the damned decision.
when I presented ths idea to my brother he said: sure, fine. But in most all circumstances the piece of paper is worthless and a medical professional will look to your DH for these plug pulling decisions.
Fortumqtely,, DH has seemed to come around and now I regularly drill him on my thoughts about plug pulling and I emphasize NO feeding NO hydratin tube lots of morphne.
How can they rule the piece of paper worthless?!?!
iris lilies
6-1-16, 6:18pm
Terry, very interesting!
Teacher Terry
6-1-16, 6:19pm
IL: that is really sad what happened to your friend.
iris lilies
6-1-16, 6:23pm
How can they rule the piece of paper worthless?!?!
Theoretically if this happened, my brother would be in another state. Paper not in evidence.
DH would be the spouse on site. More power.
Those pieces of paper (living will and power of attorney) aren't implemented until some criteria are met. Is the paper in the hospital record system? Did the doc see it? Is the patient deemed ill enough to invoke the power of attorney? Is the power of attorney present? Do we think the patient has changed their mind? Is the patient able to tell us they have not changed their mind?
As you can see, there's many loopholes.
I've seen it with my own eyes many times and I work in psych - not even in ICU.
Oh .., and is the patient suicidal? Cause if so, we must treat that depression before following a DNR ... Etc etc
I thought everyone might find this interesting about how the US compares to other countries on the cost of end of life care.
Cost of End-of-Life Care in the U.S. is Comparable to Europe and Canada, Finds New Penn Study
First Analysis of the Differences in Treatment and Costs of End-of-Life Care Among Developed Countries Shows Room for Improvement Across the Board
huh, surprising. I never understand why articles like this don't mention hospice directly as a solution, esp since they say most people would opt to die at home. Dying at home with no help in no picnic
Teacher Terry
6-1-16, 7:49pm
IN the limited experience I have had with hospice they have been awesome!
With you on this! Pull the plug with extreme prejudice!
I trust my sis on this. She is very science and evidence-based. She won't sit around thinking: "A miracle could happen!"
She'd be like: "He said pulling friggin' plug!"
don't just say it, appoint her your healthcare proxy, if you don't have one in place they go to your closest relative, which they may consider your parents, in which case, if they can't let go of the hoard, how the heck do you expect them to let go of you!
Everyone needs a proxy no matter how healthy you are
Those pieces of paper (living will and power of attorney) aren't implemented until some criteria are met. Is the paper in the hospital record system? Did the doc see it? Is the patient deemed ill enough to invoke the power of attorney? Is the power of attorney present? Do we think the patient has changed their mind? Is the patient able to tell us they have not changed their mind?
As you can see, there's many loopholes.
I've seen it with my own eyes many times and I work in psych - not even in ICU.
Oh .., and is the patient suicidal? Cause if so, we must treat that depression before following a DNR ... Etc etc
if you live in a state that uses MOLSTs, most of this is addressed and they are respected documents that theoretically follow the patient wherever they go
i wont swear, but I would want a very pointed estimate of recovery chances. I am definately on the side of "giving in."
It is so complicated, ugh. A fellow we know recently succumbed to lung cancer. He was ready to die, his dipshit sister drug his mother and various other family from out of state to visit him. A last goodbye. They sat around his bedside crying and urging him to "fight." He gave in, had a feeding tube installed, they left town. That feeding tube caused problems and pain, he had allergic reactions to morpine ao,that asnt much help, it all just prolonged his agony.
So not worth it.
that is so sad. I read a study about putting feeding tubes in end stage Alzheimer's patients, they did not live significantly longer and had reached a very poor quality of life stage, often the tube caused needless complications. The body knows how to die, when it naturally stops eating and drinking, it is a much more comfortable way to die (as you become dehydrated endorphins are released) without feeding tubes and IV fluids.
As for death panels, I don't even think we need them if doctors will speak more openly about death. Somewhere sound .5% of advanced cancer patients will even survive resuscitation and those that do end up on a vent never to come off. If oncologists shared this info readily, more end stage cancer patients would choose DNR and hopefully hospice. There are similar stats for other end stage diseases.
Not only doctors! As a culture we need to talk about death as a part of life. It is such a feared and avoided topic. I'm always surprised how surprised people are when I talk about my Dad, brother, brother-in-law and Mom who have all died. Especially my brother who committed suicide.
There is so much to teach and learn about attitudes about death. We don't have to like it but we certainly need to accept it. Mom's wise words just weeks before she died.
It is such a huge fear in this country. Life at all cost. It truly makes me crazy.
Being a "seasoned" OR RN, you cannot even imagine what I have seen and heard. Suffice it to say I was VERY young when I realized the value of death with dignity. I became insistent that we did not need to rush patients upstairs to "die" but rather, let's wait those minutes, bathe the patient here, take them to the recovery room, put up privacy screens, and bring the family in for quiet private goodbyes. Stop the insanity!!!!!
Get a living will recorded. Designate a Power of Attorney. Do it now! Be VERY clear with your POA. Be sure it's someone who will carry out your wishes.
I thought everyone might find this interesting about how the US compares to other countries on the cost of end of life care.
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At the end please note this is specific ONLY to Cancer patients. I would expect this result. This is not ALL end of life. Taken out of context is not reality.
freshstart
6-2-16, 12:24pm
Being a "seasoned" OR RN, you cannot even imagine what I have seen and heard. Suffice it to say I was VERY young when I realized the value of death with dignity. I became insistent that we did not need to rush patients upstairs to "die" but rather, let's wait those minutes, bathe the patient here, take them to the recovery room, put up privacy screens, and bring the family in for quiet private goodbyes. Stop the insanity!!!!!
Get a living will recorded. Designate a Power of Attorney. Do it now! Be VERY clear with your POA. Be sure it's someone who will carry out your wishes.
I agree with you, I was a newbie nurse on an oncology ward where I would be asked to give chemo one minute and take it down and prepare them for the hospice discussion the next, when it was obvious for weeks they were dying. The conversations I overheard as the doctor finally addressed the huge elephant in the room were less than therapeutic and I knew young I would eventually end up in hospice.
Teacher Terry
6-2-16, 1:04pm
Gard: I did read the whole article and saw it was for cancer patients only. Would love to read any other articles that people find on this subject.
iris lilies
6-2-16, 8:45pm
Gard: I did read the whole article and saw it was for cancer patients only. Would love to read any other articles that people find on this subject.
I poked around Medline and there are articles on this topic.
One, published in the Journal of Public Health, refutes the popular idea that huge percentages of health care dollars are spent in the last year of life.
It is titled"The Myth Regarding the High Cost of End of Life Care" by Melissa Aldridge and says that their study showed 13% of health care dollars were spent on people in their last year of life.
Still, I Think 13% is a lot! They also had another interesting breakdown:of the people who had very high healh care costs in the year of the study, 11% were in their last year of life.
If you Google this article it seems to be available several places on the web.
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