Wednesday, January 25, 2012

cost of dying, by cause in Canada

http://www.theglobeandmail.com/life/health/end-of-life/how-much-does-dying-cost-canadians/article2252845/

Almost 70 per cent of people die in the hospital, including some in high-tech intensive-care beds, which cost about $1-million a year to operate. Many patients fail to complete advance directives or communicate preferences to their families, meaning they could be subject to costly, invasive treatments they did not actually want.

...

Prof. Fassbender’s research shows it costs the health-care system about $39,947 to treat a patient with organ failure near the end of life; $36,652 for a terminal illness; and $31,881 for frailty. Sudden death is the least costly at $10,223.

...

Some suggest that by filling out advance directives, it can help ensure that patients receive treatments they want at end of life. The Royal Society of Canada’s report on end-of-life decisions earlier this month pointed out the need for people to express their wishes.

Hugh Walker, adjunct professor of health economics at Queen’s University medical school, who did studies on costs of care for dying cancer patients, knows this issue well, which is why he has an advance directive.

“Lots of people, my wife and I included, have signed ‘do not resuscitate’ or ‘do no heroic intervention’ orders,” said Dr. Walker, who at 73, still works. “… We don’t want to live our lives in a long-term setting and we didn’t want the other one to have a long life of disability.”

And yet, end-of-life wishes and the costs of care associated with it remain taboo topics in Canadian health care.

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D - clearly, lowering death by cancer and dementia involve long-term policies outside of health care proper. Nutrition for cancer, and fostering a culture of life-long learning for dementia.

http://leas.ca/Toxins-in-Household-Products.htm

Product
Silica Trisodium
nitrilotriacetate Methylene
chloride Naphthelene Ethoxylated
nonyl-phenol 2-butoxyethanol Toluene Xylene

D - yet there are known hazardous chemicals in Canadian households still. The European precautionary principle would seem more wise.

http://en.wikipedia.org/wiki/Precautionary_principle

The precautionary principle or precautionary approach states that if an action or policy has a suspected risk of causing harm to the public or to the environment, in the absence of scientific consensus that the action or policy is harmful, the burden of proof that it is not harmful falls on those taking the action.

D - my blog on dementia covers the lifestyle changes required to avoid dying from the 'top 10' ways to die. The key lesson is to realize that nobody wants to die from the slowest, most painful, and most ultimately terminal ways to go - dementia and cancer. Morbid as it sounds, our gov't policy should be to enhance the likelihood of a 'good death' - as compared to those 2 ways. Both the patient and the public purse are in agreement on this.

D - my additional proposal in the short term is this: require signing a check-box of 'living will' options when either a
1) driver license or
2) OHIP (health) card
gets renewed. In this fashion, the citizen and patient is encouraged -enabled - to choose for themselves so that their families do not over-ride their end-of-life treatment choices at great expense.
This policy would have a nearly immediate impact on health care costs, and the results would be visible even in this political term.

Harper still will pay +6% per year until c. 2014. After that the federal transfer will typically decrease, certainly compared to increasing costs to treat ageing Boomers. Ontario is also worse off with the new formula since the rapid rate of exporting raw commodities in the West has raised our currency, gutted our manufacturing sector, and left us with an ageing population.

Ontario faces a credit rating downgrade. EVERY option needs to be on the table. This 1 is a no-brainer, and avoids the 'third rail' issue of euthanasia and assisted suicide. The patients simply chooses for themselves.

11 comments:

  1. See blog entry on dementia. It outlines lifestyle choices that can help one select how one will die. Presumably one of the 'die in your sleep' or 'die with your boots on' ones. NOT cancer or dementia.

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  3. The cost of cancer care also places a heavy burden on the health-care system. One estimate finds that over the next 30 years, 2.4 million workers will get cancer and 872,000 will die from the disease. Meanwhile, cancer will cost the Canadian economy an estimated $177.5 billion in direct health-care costs, $199 billion in corporate profits, $250 billion in taxation revenues, and $543 billion in wage-based productivity.3

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  4. D - the key is to delay disability and mortality to at least 65. Also, the key group to keep alive is young adults - society has invested as much in their education as it will, and they are about to embark on productive work lives for society to recoup its investment. For kids, that means car accidents. For young adults, suicide.

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  5. Ontario, which was hit harder than other Canadian provinces by the 2008 recession, was also the only one downgraded by DBRS during the slowdown. The province's long-term credit rating is investment-grade AA low at DBRS and AA- at S&P, all between one and three notches below the top rating that the federal government enjoys.
    The Aa1 rating by Moody's on the province is still higher than those of S&P and DBRS

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  6. Thinking about it, an alcholic drink a day pretty much just trades heart disease for an head/neck or internal cancer. At 40, I'm pondering HOW I want to die. As I've said, my 'good death' scenario matches the public's interest in a sudden and low-cost death. Since cancer is the worst, and heart disease (or stroke) is not, and is more likely to be sudden and instant, I don't think that 1-2 drinks a day makes sense. It is not WHEN you die- it's HOW. Society's interest in when - what age - ends at retirement, when an ex-worker becomes a next cost instead of net contributor to the tax base.

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  7. (from Dying with dignity website)
    Angus Reid poll shows that 85% of Canadians “believe legalizing assisted-dying would give people who are suffering an opportunity to ease their pain and 76% believe it would establish clearer guidelines for doctors to deal with end of life decisions”. DWD loses charitable status due to non filing of documents.

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  8. WASHINGTON — Many baby boomers don't have end-of-life legal documents such as a living will -- and some say it's because they feel healthy and young in their middle-age years and don't need to dwell on death.

    An Associated Press-LifeGoesStrong.com poll found that 64 per cent of boomers -- those born between 1946 and 1964 -- say they don't have a health care proxy or living will. Those documents would guide medical decisions should a patient be unable to communicate with doctors.
    Read more: http://www.ctv.ca/CTVNews/Health/20111116/baby-boomers-living-wills-111116/#ixzz1lwTAM8y6

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  9. I just realized the age group beneath the Boomers (who are 46 to 64). 65 to 56. 1965 to 2056. Cuz they'll be almost done gutting the nation in 2060, when those last kids are born.

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  10. http://digg.com/newsbar/topnews/why_doctors_go_gentle_into_the_night Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life. D- morbid stuff. I took CPR. After the first 'golden minute' of high-chance revival, we are really just keeping the organs fit for transplant.

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  11. http://www.cbc.ca/news/canada/story/2012/03/20/cancer-work-plastic.html

    D - lax gov't enforcement of safety rules makes this more common than one might think.

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