Cost does Not Always Equal Value
If you have been paying any attention over the last months, you are aware of the growing conversation in our country about health care costs. Much of it is focused on large policy issues, but some is directly relevant for us. The Choosing Wisely campaign, organized by the Board of Internal Medicine, or the Institute of Medicine's September report about high quality cancer care in a time of crisis have helped focus top level attention on cancer costs. This matters to us individually, to our families, to our country as a whole. Of course, we all want the best possible care for cancer or any illness, but most of us also want care that makes sense and keeps the attention on our own goals and priorities.
This is a superb article from The Washington Post about these issues. To quote:
The IOM makes plain that our cancer care system is particularly poorly organized to properly care for people with advanced cancers. As outlined by Thomas Smith and Bruce Hillner in a now-classic piece, too many patients are subjected to punishing and futile treatments. Too much costly imaging is performed, for too little therapeutic benefit. Too often, costly supportive therapies, such as Epogen, that raise red blood cell counts are provided when they are not needed. The lack of easily used electronic health records aggravates fragmentation of care and perpetuates miscommunication and medical errors.
This isn’t an issue of rationing. America can amply afford the $125 billion we devote to cancer care. Cancer accounts for only about 5 percent of our nation’s $2.8 trillion health-care economy. Yet particularly in the case of advanced cancers, both patients and the wider society could receive greater value for what is spent. Many patients require care delivered with greater thoughtfulness: less-toxic treatment regimes that relieve suffering and protect quality of life when curative care is not possible.
The article goes on to include a thoughtful interview with several patients who are living well with Stage IV cancers, making treatment choices that fight the cancer while giving the highest priority to their quality of life. This is well worth reading.