Canterbury spends half its health dollars on the one- seventh of the population who are over 65, the health board’s annual plan shows. The figure has sparked calls for New Zealand to invest more in end-of-life care rather than treatment for the dying.
The Canterbury District Health Board’s annual plan said about half its resources were spent on services for people over 65. Canterbury’s use of residential care and home-based support services was higher than the national average, and the board’s “greatest challenge”. In 2009, Canterbury’s over – 65 population was about 80,000. That was expected to rise to 100,000 by 2016.
Geoff Simmons, who has co-authored books on New Zealand healthcare with fellow economist Gareth Morgan, said most of that money was being spent in the final years of people’s lives. Overseas studies suggested about a quarter of all money for a person’s healthcare was spent in their last two years, whether they died at 65 or 95, Simmons said. “A lot of treatments at the end of life are both damaging to quality of life and expensive, and all for a very small [if any] gain in length of life.” Overseas studies showed that when informed about their options, about one- quarter of people chose to have less treatment and more care. As the population aged, it would be the young who missed out on things such as preventive healthcare to fund treatments for the dying, Simmons said.
Auckland palliative care specialist Professor Rod MacLeod said the percentage of health dollars spent on those over 65 was likely to rise as people lived for longer with disease. New Zealand had a “significant workforce shortage” for end-of-life care, with less than 30 specialists working in palliative medicine. “Hospitals are very good at managing disease, but really you have to be able to stand back once the immediate crisis is over and say how is the best way to manage this person in the context of family and community?” If doctors did not know about the palliative-care options, they could not offer them to patients. “I don’t think people should be denied treatments because they are old, but certainly given all the options so they don’t have this fear of dying in pain or alone,” MacLeod said.
More than one-third of people died in hospital. “Most New Zealanders would choose to go home to die” he said. “We have to make sure we have services in the community which are good enough and safe enough 24 hours a day. It’s a lot cheaper to stay at home.” A recent article in the New Zealand Medical Journal said an audit of Christchurch Hospital admissions showed that over one week, two-thirds of general medical admissions were for people over 65, and half of those were over 80. About a third of general surgical admissions were for people over 80.
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