Speaking of those that bleat the loudest, last week Counties Manukau DHB (CMDHB) released a report in the New Zealand Medical Journal about the costs of treatment in the last year of life. Each of the 2290 people that died in the CMDHB received treatment costing an average of $22,000 each, totalling $51 million overall, about 5% of the DHB’s health budget. Such costs are in line with overseas research, though similar work has never been undertaken in New Zealand. Up until now, Treasury used a guesstimate of $10,000 per person in their last year of life – that estimate is now blown out of the water.
This excellent work by CMDHB further highlights the future issues our health system faces. While our generation of baby boomers seem set to stay healthy for longer, they show no sign of giving up their entitlement mentality and will no doubt demand gold-plated care at the end of their lives. At the same time we will be facing a tsunami of diabetes and mounting superannuation costs. Will the younger generations stick around to shell out for all of their parents bills?
The irony is that a lot of this treatment is excessive and some can cause more harm than good to the patient. We need to start talking about what we value in life, and the downsides that treatment often brings. If people are fully informed about the downsides of treatment, they will often choose not to receive it, and instead try to fully enjoy what life they have left.
Meanwhile we see the cost of pouring more money into people at the end of their lives through reduced investment in preventing diseases, as we saw in the rheumatic fever example above.
This is an issue that needs urgent debate, but is too hot for the politicians to touch. All the more reason to get them out of the process of allocating healthcare resources altogether, as we advocated in Prescription for Change.
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